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Date:
Loan Agent you spoke to::
PreQualification
Equity
Debt Consolidation
Refinance
Amount Requested:
Purpose:
Name:
DOB:
S.S Number:
Co-Applicant:
DOB:
S.S Number:
Address:
City:
State:
Zip:
Year Purchased:
Amount Paid:
Current Value:
1st Mortgage Holder:
Balance:
Payment:
Percentage Rate of Loan:
%
15 YR.
20 YR.
30 YR/ARM OR FIXED
2nd Mortgage Holder:
Balance:
Payment:
Percentage Rate of Loan:
%
15 YR.
20 YR.
30 YR/ARM OR FIXED
Prepayment Pentaly on 1st or 2 nd
YES
NO
Expiration:
Amount:
Employer:
Years:
Annual Salary:
Employer:
Years:
Annual Salary:
Home Phone:
Business Phone:
How would you rate your credit?
Fair
Good
Excellent
Have you ever filed Bankruptcy?
YES
NO If So, Year Discharged
Have you missed or been over 30 days late in the past year on your mortgage?
YES
NO
Have you been over 30 days late on any other debts?
YES
NO
What is you combined credit card debt? $
What is your combined monthly paymenty? $
Do you have an auto loan?
YES
NO Balance: $
Montly Payment: $
Do you have any other loans?
YES
NO Balance: $
Payment: $
Do you own any other property?
YES
NO Balance: $
Payments: $
If Yes, How much equity do you have? $
May we run a credit check?
YES
NO
How did you hear about us?:
Email:
Comments:
Last Updated ( Wednesday, 10 December 2008 )
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