BORROWER
NAME:
ADDRESS:
ADDRESS:
CITY:
STATE
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
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
ZIP
SOCIAL SEC. #:
-
-
BIRTHDATE:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
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19
20
21
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31
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
CO-BORROWER
NAME:
ADDRESS:
ADDRESS:
CITY:
STATE
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
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
ZIP
SOCIAL SEC. #:
-
-
BIRTHDATE:
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
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
CURRENT PROPERTY INFORMATION
YOU CURRENTLY:
RENT
OWN
YEARS AT ADDRESS?:
Under 1 Year
1 Year
2 Years
3 Years
4 Years
5 Years
5 To 10 Years
11 To 15 Years
16 To 20 Years
More Than 20 Years
PRE-APPROVAL REASON?:
Refinancing
Purchase Primary
Purchase Second
Investment Property
PREFERRED METHODS OF CONTACT
EMAIL:
HOME PHONE: (
)
-
WORK PHONE: (
)
-
CELL PHONE: (
)
-
BEST CONTACT TIME:
12:00
11:00
10:00
9:00
8:00
7:00
6:00
5:00
4:00
3:00
2:00
1:00
AM
PM
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