AMOUNT REQUESTED:

Home Improvement

Payoff bills

Consolidation

Delinquent Taxes

BORROWER

 

CO - BORROWER

 

NAME :

NAME :

SS# :

SS# :

MARITAL STATUS :

MARITAL STATUS :

# OF DEPENDENTS :

# OF DEPENDENTS :

DATE OF BIRTH :

DATE OF BIRTH :

ADDRESS :

ADDRESS :

CITY :

CITY :

ZIP :

ZIP :

PH# :

PH# :

FAX# :

FAX# :

HOW LONG AT RESIDENCE :

PROPERTY TYPE : SFR OR # OF UNITS :

IS THE PROPERTY BRICK OR FRAME ?

HOW MANY BEDROOM ?

HOW MANY BATHS ?

BASEMENTS ?

FULL FINISHED

PARTIAL FINISHED

UNFINISHED

GARAGE ?

HOW MANY CARS ?

PROPERTY ADDRESS (IF DIFFERENT) :

BORROWER

 

CO - BORROWER

 

EMPLOYER :

EMPLOYER :

WORK # :

WORK # :

#OF YEARS EMPLOYED :

#OF YEARS EMPLOYED :

POSITION :

 POSITION :

GROSS MONTHLY INCOME :

 GROSS MONTHLY INCOME :

MORTGAGE COMPANY :

ARE YOU UP TO DATE ON THIS MORTGAGE ?

HOW MANY MONTHS BEHIND ?

MORTGAGE BALANCE ON 1^ST :

 MORTGAGE BALANCE ON 2^ND :

MONTHLY PAYMENT ON 1^ST :

 MONTHLY PAYMENT ON 2^ND:

INTEREST RATE ON THE 1^ST :

 INTEREST RATE ON THE 2^ND :

ANY BANKRUPTCIES :

WHEN WAS THE BK FILED :

ORIGINAL COST OF THE HOME :

APPRAISED VALUE OF PROPERTY :