Loan Officer/Mortgage Broker
Yes No
Borrower Info

Yes No
Mailing Address


Personal Info
 Unmarried  Married  Separated
 U.S. Citizen  Perm Resident Alien  Non-Perm Resident Alien
Yes No
 Currently serving on active duty
 Currently Retired, discharged, or separated from service
 Non-activated member of the Reserve or National Guard
 Surviving Spouse
Business Entity
Yes No
 

 Subject Property Details

  Property Location

  Property Characteristics

  Property Details

$
In Month

  Property Access

Yes No
VENDOR & EQUIPMENT INFORMATION
 
Loan Terms
$
Yes No
Yes No
$
$

$


$
$
$

%

%

Insurance Company Info
Borrower Employment Information
I have ownership share of less than 25%
I have ownership share of 25% or more
Weekly   Monthly   Every 2 weeks   Twice a month


Borrower Monthly Income
$
$
$
$
$
$

$

(Borrower)