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    Appointment Date

    Appointment Time

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    Loan Officer

    PRIMARY BORROWER

    First Name

    Middle Name

    Last Name

    Phone #1

    Phone #2

    Phone #3

    Email #1

    Email #2

    Address

    City

    State

    Zip Code

    How Long

    If you live less than 2 years in your current address, Previous address is necessary

    Previous Address

    City

    State

    Zip Code

    How Long

    Rented / Owned

    Marital Status

    Date of Birth

    Dependents

    Age(s)

    Social Security #

    Retired

    Years

    Estimated FICO

    PRIMARY EMPLOYMENT INFORMATION

    Name

    Address

    Telephone#

    Position

    Years

    Income

    CO-BORROWER

    First Name

    Middle Name

    Last Name

    Marital Status

    Dependents

    Age(s)

    Date of Birth

    Social Security #

    Retired

    Years

    Estimated FICO

    CO-BORROWER EMPLOYMENT INFORMATION

    Name

    Address

    Telephone #

    Position

    Year

    Income

    SUBJECT PROPERTY INFORMATION

    Estimated Value

    Estimated Value 2

    Purchase Date

    Year Built

    Amount Paid

    Conv 80% LTV

    Est. Available Equity

    FHA 85% LTV

    Est. Available Equity

    CURRENT LOAN & HOI

    Current Loan Type

    Current Lender

    Interest Rate

    Loan Balance

    Escrow Balance

    Term

    Fixed / Arm

    Monthly Payment

    Principal

    Interest

    Escrow

    Tax

    HOI

    PMI / MIP

    Annual Tax

    Annual HOI

    HOI Renewal Month

    HOI Company

    HOI Policy #

    HOI Phone #