Property Information and Purpose of Loan
Subject Property Address (street, city, state, ZIP):
Street City State Zip Code
Purpose of Loan:
Purchase     Refinance     2nd Trust Deed     Equity Loan     Other, (explain)
If purpose of loan is other, please explain below:

Property will be:
Primary Residence     Secondary Residence     Investment
Year Acquired                              Original Cost                                  Amount Existing Liens
         
Source of Down Payment, Settlement Charges and/or Subordinate Financing (explain)

Borrower/Co-borrower Information
I.  Borrower's name: (include Jr. or Sr. if applicable)

Social Security Number     Home Phone (incl. area code)
Present Address (street, city, state ZIP):     Own     Rent

If residing at present address for less than two years, complete the following:
Former Address (street, city, state, ZIP): Own     Rent       Number of Years
Street City State Zip Code

II.  Co-borrower's name: (include Jr. or Sr. if applicable)

Social Security Number     Home (incl. area code)
Present Address (street, city, state, ZIP):     Own     Rent     
Street City State Zip Code
If residing at present address for less than two years, complete the following:
Former Address (street, city, state, ZIP):     Own     Rent     Number of Years
Street City State Zip Code

Employment Information
I.  Borrower
Name & Address of Employer
Employer Name Street City State Zip Code
Position/Title/Type of Business                                                                                Years on this job:
Position Title Type of Business
Business Phone (include area code):

II.Co-borrower
Name & Address of Employer
Employer Name Street City State Zip Code
Position/Title/Type of Business                                                                                Years on this job:
Position Title Type of Business
Business Phone (include area code):

Monthly Income & Combined Housing Expense Information
Gross Monthly Income                    Borrower                                  Co-Borrower                    
Base Empl. Income                       
Overtime                                       
Bonuses                                       
Commissions                                
Net Rental Income                        

Combined Monthly Housing Expense -- PRESENT

Declarations 
If you answer "yes" to any questions a through e, please use scroll box below for explanation(s)          Borrower          Co-Borrower          
a.  Are there any outstanding judgments against you?                                                                                Y  N       Y  N
b.  Have you been declared bankrupt within the past 7 years?                                                                   Y  N       Y  N
c. Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?          Y  N       Y  N
d.  Is any part of the down payment borrowed?                                                                                          Y  N       Y  N
e.  Are you a co-maker or endorser on a note?                                                                                           Y  N       Y  N