Loan Information:
	Loan Purpose:	Property Type:
	Purchase Refinance Home Equity Line of Credit Construction to permanent Refinance - Debt Consolidation Refinance - Home Improvement Refinance - No Cash Refinance - Other	---------------------- Primary Residence Secondary Residence Investment Vacation Other
	Loan Amount:	Interest Rate:
	Down Payment:	Property Market Value:
	Property Address:	Sales Price
	* Property to be purchased
	City, State, Zip Code:
	Present Mortgage Information
	Current Mortgage Company
	Current Mortgage Balance
	Current Mortgage Payment
	Current Interest Rate
	Borrower Information
	First Name:	M.I.:	Last Name:
	Social Security Number:	Marital Status:
		------------------- Single Married Separated Divorce
	Home Phone Number:	E-mail Address:
	Age:	Years of School:
	Present Employer - Purchaser (1)
	Employer	Position
	Department	Employer Address
	Date employed (month / year)	Gross monthly income
	Phone	Net monthly income
	Present Employer - Purchaser (2)
	Employer	Position
	Department	Employer Address
	Date employed (month / year)	Gross monthly income
	Phone	Net monthly income
	Other Income
	Source	Monthly gross
		Monthly net
	Alimony, child support or separate maintenance income need not be revealed if purchaser does not wish to have it considered as a basis for repaying this obligation.
	Auto Information
	Year
	Make and Model
	Year
	Make and Model
	Bank Information
	Account Type	Checking
		Savings
	Bank Name / Location	Average Balance
	Account Type	Checking
		Savings
	Bank Name / Location	Average Balance
	Previous Address (If less than 3 years at present)
	Street address	City		State	Zip
	How long at the previous address
	Co-Borrower Information
	First Name:	MI:	Last Name:
	Social Security Number:	Marital Status:
		------------------- Single Married Separated Divorced
	Home Phone Number:	E-mail Address:
	Age:	Years of School
	When is the best time to contact you?	Early morning Late morning Early evening Late evening
	Where is the best place to contact you?	Work Home
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