Are you working with a Realtor yet? Yes           No
Your Realtor contact information
Borrower Information

Borrower's Full Name
Email address
Married Yes       No
Home Phone
Cell Phone
Work Phone
Fax
Are you a Veteran Yes       No
Are you disabled? Yes       No
If yes, what percent?
Reserves or Regular Military? Reserves       Regular military
Have you used your va benefit before? Yes   No
Please list activity duty dates:
(If you were active more than once, please list complete dates for each tour of duty)
Social Security Number
Date of Birth
Sex
Race
Gross Income
How often are you paid that amount?
Other Income
(retirement, social security, disability, child support, 2nd job, etc.)
Employer Name
Employer Address
Employer Phone
Job Position/Title
How long there?
How long in line of work?
Prior employment
(If less than 2 years)
Current Home Address
How long have you been at this address?
Prior Address
(If less than 2 years)
Do you Rent or Own? Rent           Own
Monthly Payment
Co-Borrower Information

Co-Borrower's Full Name
Email Address
Married Yes       No
Home Phone
Cell Phone
Work Phone
Fax
Are you a Veteran Yes       No
Are you disabled? Yes       No
If yes, what percent?
Reserves or Regular Military? Reserves       Regular military
Have you used your va benefit before?" Yes        No
Please list activity duty dates:
(If you were active more than once, please list complete dates for each tour of duty)
Social Security
Date of Birth
Sex
Race
Gross Income
How often are you paid that amount?
Other Income
(retirement, social security, disability, child support, 2nd job, etc.)
Employer Name
Employer Address
Employer Phone
Job Position/Title
How long there?
How long in line of work?
Prior employment
(If less than two years)
Current Home Address
How long have you been at this address?
Prior Address
(If less than 2 years)
Do you Rent or Own? Rent           Own
Monthly Payment
Miscellaneous Loan information
When are you looking to move?
Is Borrower married to Co-Borrower?
New property City or address
Max you can afford per month for new home
Estimated value of new home.
(if you already have a value in mind)
Assets - please list
all accounts where you have a cash balance and the dollar amount you have in
each account

(e. g. Checking/Savings/401k/Stocks/IRA/Mutual Funds/CD’s, etc.)
Intended down payment amount
Amount you want to bring to closing
What can you tell me about your credit?
Do you own other homes? Yes           No
if yes, what is address and market value of each
Additional notes if needed:
Additional Information if this is a refinance
Date you purchased this home
(month & year)
Original price
How long do you plan to stay here / own this property
What is the PURPOSE of this new loan?
(to lower rate, payoff debt, go from arm to fixed, etc.)
What is your desired loan term
(10, 15, 20, 30 yrs, etc)
Do you want Fixed or Adjustable rate Fixed          Adjustable
How old is your current loan
(date opened or last refinanced)
If you have refinanced before, did you take money out or pay off debt
What is your current loan balance
What is your current interest rate
Is current loan Fixed or ARM
What is current loan term length (10, 15, 20, 30 yrs, etc)
Are there any other liens/loans to pay off
(2nd lien, pool loan, etc)		 Yes           No
Current Monthly Payment
Do you currently escrow? Yes           No
Do you want to continue to Escrow? Yes           No
Estimated Value of Home
(Current Market Value)
Amount of your Yearly Homeowners Insurance Premium
Renewal Date of your Yearly Homeowners Insurance Premium
Insurance Agent & Phone number
Amount of annual property taxes