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	Complete the following form to the best of your abilities to begin the application process. Though we will need additional information such as your current assets and liabilities, completing the fields below will speed your application process. Primary Borrower Information Please specify your full legal name (Include Jr. or Sr., if applicable) First Name: Middle Name: Last Name: Date of Birth: Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Choose one... 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 Marital Status: Choose one... Married Unmarried Separated * Note: Unmarried includes single, divorced, widowed. Do you rent or own? Choose one... Rent Own Living Rent Free Current Address: City: State: Choose one... AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY Zip Code: Home Phone Number:   Work Phone Number:   Cell Phone Number: Best Time to Call: Choose one... Weekdays Evenings Weekends What was your gross annual income for 2003?   What was your gross annual income for 2004? Are you self employed? Choose one... Yes No How many years have you been with your current business? If less than two years, have you remained in the same type of employment? Choose one... Yes No N/A What is your current home value? What is the current interest rate on your home? What is the amount you owe on your current first mortgage? How much are your taxes? Choose one... Annual Monthly How much is your hazard insurance for your home? If there is a second mortgage, what is the current balance? If you have any credit card obligations, please list below: 1. Credit Card Balance: Monthly Payment: 2. Credit Card Balance: Monthly Payment: 3. Credit Card Balance: Monthly Payment: 4. Credit Card Balance: Monthly Payment: 5. Credit Card Balance: Monthly Payment: Do you have any reserves such as 401K, IRA, stocks, bonds, cash value life insurance, or savings accounts? Choose one... Yes No If you own any other properties, please list each. Property 1: Current Loan Balance: Monthly Payment: Monthly Rental Income: Property 2: Current Loan Balance: Monthly Payment: Monthly Rental Income: Property 3: Current Loan Balance: Monthly Payment: Monthly Rental Income: Property 4: Current Loan Balance: Monthly Payment: Monthly Rental Income: Property 5: Current Loan Balance: Monthly Payment: Monthly Rental Income: Email Address: How did you find out about us? Choose one... Search Engine Radio Friend Other If Other, please specify: Loan Information Purpose of Loan: Choose one... Purchase, property has been identified Purchase, I am still looking for a property Refinance Construction Construction-Permanent Home Equity Loan/Line Home Improvement/Debt Consolidation Property Value: $ Loan amount you are applying for: $ or % Down payment Is there a co-borrower? Choose one... Yes No In which state are you looking for a loan? Choose one... AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY Do you currently own any real estate? Choose one... Yes No How is your credit? Choose one... Excellent OK, but some problems Major credit problems Don't know Preferred Loan Program: Choose one... Conforming 30 year fixed Conforming 30 year fixed biweekly Conforming 20 year fixed Conforming 15 year fixed Conforming 15 year fixed biweekly Conforming 10/1 ARM Conforming 30/7 or 7/1 ARM Conforming 30/5 or 5/1 ARM Conforming 3/1 ARM Conforming Adjustable Conforming 40 year fixed Conforming 10 year fixed Conforming 25 year fixed Jumbo 30 year fixed Jumbo 30 year fixed biweekly Jumbo 20 year fixed Jumbo 15 year fixed Jumbo 15 year fixed biweekly Jumbo 10/1 ARM Jumbo 7/1 ARM Jumbo 5/1 ARM Jumbo 3/1 ARM Jumbo Adjustable Jumbo 40 year fixed Jumbo 10 year fixed Jumbo 25 year fixed FHA 30 year fixed FHA 15 year fixed FHA Adjustable VA 30 year fixed VA 15 year fixed VA Adjustable Conforming 1 month COFI ARM Conforming 3 month COFI ARM Conforming 6 month CD ARM Conforming 1 year tbill ARM Jumbo 1 month COFI ARM Jumbo 3 month COFI ARM Jumbo 1 year tbill ARM Don't know Property Information Address: City: State: Choose one... AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY Zip Code: Property type: Choose one... Single Family Condominium Townhouse Cooperative Duplex Triplex Fourplex Planned Unit Development Other Don't know Year built: Property will be: Choose one... Primary Residence Secondary Residence Investment (rental) Title will be held in what name(s): Manner in which title will be held: Choose one... Husband and wife as joint tenants Tenants in common Community property Single man Single woman Unmarried man Unmarried woman Trust Married woman Married man To be determined later Please enter any comments that could be helpful in processing your application:
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