BORROWER / AUTHORIZED SIGNER INFORMATION

Status

First Name And Last Name

Maritial Status

Country

Address

* Must match official identification document and documents pertaning to this loan

City

County

State

Zip Code

Do you own or rent your primary residence:*

Number of years at primary residence?

Mailling Address (If different from primary residence)

Primary Phone Number

Secondary Phone Number

Date of Birth

Social Security Number (N/A Foreing National)

Employment Information

Self-Employed

Employer Name

Position & Title

Employer Address

DECLARATIONS / QUESTIONNAIRE		Borrower
Please check YES or NO for each of the following questions	Yes	No
Are there any outstanding judgments against you?
Have you been declared bankrupt within the last seven (7) years?
Have you or any other entity of which you were/are a principal been in foreclosure or had any property that was foreclosed upon?
Are you party to a lawsuit?
Are you currently delinquent on any federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee?
Have you ever been convicted of a felony?
Are you in a Civil Union or a Domestic Partnership, or do you have a non-borrowing spouse, or are you a party to a Designated Beneficiary Agreement?
Are you a US citizen?
Are you a permanent resident alien?
Do you intend to occupy the property as your primary residence?

Estimated Total Annual income

Estimated Current Liquid Assets

Cash in Bank

Real Estate Owned(Net of All Debt )

Add Co-Borrower (if applicable)

Full name	Date of Birth	Phone	Email	Address	City	State	Zip code

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