LOAN APPLICATION FORM

Borrower Information

Are you _ Married _ Single _ Divorced

Full Name:

Date of Birth:

Current Home Address:

City:

State:

Zip Code:

How long have you lived at this address:

Social Security Number:

Home Phone:

Work Phone:

Cell Phone:

E-mail Address:

_Own

_ Rent

Current Mortgage Company:

Landlords Name:

Monthly Payment: $

Monthly Rent Payment: $

Employment Information

Current Employer:

Are you self employed _Yes _No

Employer Address:

City:

State:

Zip Code:

Job Title/Description:

How long have you worked for your current employer:              Years                   Months

Start Date:

Please describe your compensation: (Hourly, Salary,  Commission, Bonuses, etc.

Hourly: $                                      /hour

You work: #                       /hours per week

Salary:                                            /yearly

Commission: $

Bonus: $

Terms:

Terms:

Please list previous or secondary employment

Employer:

_ Previous _Secondary

Self employed: _Yes _No

Employer Address:

City:

State:

Zip Code:

Employer Phone Number:

Job Title/Description:

Years/Months in this line of work:

Start Date:

End Date:

Hourly: $                                          /hour

You work: #                  /hours per week

Salary:                                            /yearly

Commission: $

Bonus: $

Terms:

Terms:

Assets

Checking Account

$                         Appx Balance

Bank:

_Borrower _Co-borrower

Savings Account

$                         Appx Balance

Bank:

_Borrower _Co-borrower

Retirement Account (401K)

$                         Appx Balance

Bank:

_Borrower _Co-borrower

Other:

$                         Appx Balance

Bank:

_Borrower _Co-borrower

Real Estate Owned

If you own your home what is the current value: $

What was the purchase price: $

What year did you buy your home:

Monthly payment escrowed:  _Yes _ No

Do you own:      _ Vacation Home     _ Secondary Home      _Investment Property

Current Value:$

Purchase Price: $

Address:

City:

State:

Zip Code:

Purchase Date:

Monthly payment escrowed:  _Yes _ No

How is your credit history :   _ Excellent    _ Good   _Average   _ Challenged   _ I Have No Credit History

Do any of these apply:   _Bankruptcy  _ Judgments  _Tax Lien  _ Divorce _ Child Support

Other:  Additional Information you would like to add

Borrower Print Name:   X

Borrower Signature:   X

Date:

Co-Borrower Information

Are you _ Married _ Single _ Divorced

Full Name:

Date of Birth:

Current Home Address:

City:

State:

Zip Code:

How long have you lived at this address:

Social Security Number:

Home Phone:

Work Phone:

Cell Phone:

E-mail Address:

_Own

_ Rent

Current Mortgage Company:

Landlords Name:

Monthly Payment: $

Rent Monthly Payment: $

Employment Information

Current Employer:

Are you self employed _Yes _No

Employer Address:

City:

State:

Zip Code:

Job Title/Description:

How long have you worked for your current employer:                                         Years                                                      Months

Please describe your compensation: (Hourly, Salary,  Commission, Bonuses, etc.

Hourly: $                                      /hour

You work: #                       /hours per week

Salary:                                            /yearly

Commission: $

Bonus: $

Terms:

Terms:

Please list previous or secondary employment

Employer:

_ Previous _Secondary

Self employed: _Yes _No

Employer Address:

City:

State:

Zip Code:

Employer Phone Number:

Job Title/Description:

Years/Months in this line of work:

Start Date:

End Date:

Hourly: $                                          /hour

You work: #                  /hours per week

Salary:                                            /yearly

Commission: $

Bonus: $

Terms:

Terms:

Assets

Checking Account

$                         Appx Balance

Bank:

_Borrower _Co-borrower

Savings Account

$                         Appx Balance

Bank:

_Borrower _Co-borrower

Retirement Account (401K)

$                         Appx Balance

Bank:

_Borrower _Co-borrower

Other:

$                         Appx Balance

Bank:

_Borrower _Co-borrower

Real Estate Owned

If you own your home what is the current value: $

What was the purchase price: $

What year did you buy your home:

Monthly payment escrowed:  _Yes _ No

Do you own:      _ Vacation Home       _ Secondary Home      _Investment Property

Current Value:$

Purchase Price: $

Address:

City:

State:

Zip Code:

Purchase Date:

Monthly payment escrowed:  _Yes _ No

How is your credit history :   _ Excellent    _ Good   _Average   _ Challenged   _ I Have No Credit History

Do any of these apply:   _Bankruptcy  _ Judgments  _Tax Lien  _ Divorce _ Child Support

Other:  Additional Information you would like to add

Co-Borrower Print Name:   X

Co-Borrower Signature:   X

Date:

Information as a courtesy of:

(877) 552-7150-Toll Free

(540) 552-7150-Office

(540) 552-7154-Fax