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PERSONAL INFORMATION

Today's date
Today's time
Borrower: Last name
First name
Residence phone
Business phone
E-mail:
Best time to reach:
Co-Borrower: Last name
First name
Residence phone
Business phone
E-mail:
Best time to reach:
PROPERTY
Property address
City, state, zip
Property type
Property use
Purpose of refinance:
Amount of cash out:$

EXISTING LOANS / PROPERTY

	Present Balance	Monthly Pmt.	Interest Rate	Term
1st TD	$	$	%
2nd TD	$	$	%
3rd TD	$	$	%

Estimated value of property: $

Title held by:

Any late payments?

Any Bankruptcies in the last 24 months?

Any Foreclosures in the last 24 months?

Your credit rating:

EMPLOYMENT

Borrower: Self-Employed?
Type of job:
Years at job:
Monthly gross income: $
Co-Borrower Self-Employed?
Type of job:
Years at job:
Monthly gross income: $

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