Loan Application Mini 1003 From: Title: Phone: Fax: - - - - - - - - - - - - - - - - - - - - Borrower Name: E-Mail Address: Home Phone: Work Phone: Date of Birth: Marital Status: Select Married Un-Married Separated Present Address: Own Rent  Number of Years Street Address #1: Street Address #2: City: State: Zip: How would you rate your credit history? Excellent Good Issues Explain Issues: - - - - - - - - - - - - - - - - - - - - Co-Borrower Name: Home Phone: Work Phone: Date of Birth: Marital Status: Select Married Un-Married Separated Present Address: Own Rent  Number of Years Street Address #1: Street Address #2: City: State: Zip: How would you rate your credit history? Excellent Good Issues Explain Issues: - - - - - - - - - - - - - - - - - - - - Purpose of the loan: Purchase Refinance Home Equity Construction Type of loan requested: Conventional FHA VA Property will be: Primary Residence Secondary Home Investment Property Amount of Loan Requested: - - - - - - - - - - - - - - - - - - - - Monthly Income: Borrower Co-Borrower Total Base Employment Income: Overtime: Bonuses: Commissions: Other: Total: - - - - - - - - - - - - - - - - - - - - Combined Monthly Obligations Borrower & Co-Borrower Rent Payments : Mortgage Payments : Total Credit Card Payment: Other Payments : Total: - - - - - - - - - - - - - - - - - - - - Borrower Self-employed Select Yes No Co-Borrower Self-employed Select Yes No Comment or Referral By: