LMR Data Form



Please select the loan
advocate or referral source

or 


Basic Info

Information

Borrower Information
First Name
Last Name
File Type
Which services are requested?
How did you hear about us?
Is there a Co-Applicant?
Phone number
 -    -    Ext #
Cell number  -    -  
Email
 
Property Information
Property Address
Property City
Property State
County
Property Zip
Property Type
Estimated value of your home? (Enter Lowest
Value From Look-up Link)
Mortgage Information
Who is your 1st mortgage lender?
How many months are you behind?
What is the estimated balance for
your 1st mortgage?
What is the payment of your 1st mortgage?
What is your monthly property tax payment?
What is your monthly property insurance payment?
Do you have a 2nd lender?

Income and Expenses

Primary Borrower

     
Occupation?
Employment Type
Employer Information
Employer Name
Years at job
Gross Monthly Income? $
Net Monthly Income $
Social Security $
(Income Monthly)
Pension/Retirement $
(Income Monthly)
Disability $
(Income Monthly)
Child Support/Alimony $
(Income Monthly)
Room Rental $
(Income Monthly)
Monthly Income (2nd Job) $
(Monthly)
Unemployment $
(Income Monthly)
Other $
(Income Monthly)

Monthly Expenses

PRIMARY BORROWER

 
Credit Cards $
(Monthly)
Total Credit Card
Balance(s) $
Auto Loan(s) $
(Monthly)
Total Auto Loan
Balance(s) $
Unsecured Loan(s) $
(Monthly)
Total Unsecured Loan
Balance(s) $
Student Loans/Tuition $
(Monthly)
Total Student Loan
Balance(s) $
Alimony/Child Support $
(Monthly)
Child/Dependent/Elderly Care $
(Monthly)
Insurance (Auto, health, life) $
(Monthly)
Groceries $
(Monthly)
Car Expenses (gas, maint.) $
(Monthly)
Doctor/Medical Bills $
(Monthly)
Entertainment $
(Monthly)
Other $
(Monthly)

Utilities

Primary Borrower

 
Cable TV/Satellite $
(Monthly)
Electricity $
(Monthly)
Natural Gas/Oil $
(Monthly)
Telephone/Cell $
(Monthly)
Water/Sewer $
(Monthly)
Internet $
(Monthly)
Other $
(Monthly)
   
Household Expenses notes