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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 #