Borrower 1:
Full Name: SSN#
Address (line1) Address (line2)
City State Zip
Years Employed:
Salary Self Employed - Yearly Salary

Borrower 2:
Full Name: SSN#
Address (line1) Address (line2)
City State Zip
Years Employed:
Salary Self Employed - Yearly Salary

Mortgage Amount: $      Price/Value $
Purchase, Down Payment $ ( %)    Refinance

Requested Interest Rate %  Points  Term  LTV %

Requested Loan Type: Fixed       Arm       No Asset Check

Full Income Check       No Income Check       No Asset Check
Available Cash $       Gift $

Yearly Taxes $      Yearly Homeowners Insurance $
Yearly Maintenance (Co-op or Condo) $

Monthly Income $     Monthly Credit Payments$
Number of Units      Monthly Gross Rental Income $

Qualifying Ratio's /                Cash Out $