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*First		*Last
*E-mail		*Phone

Type of Loan
Loan Amount
Credit

Total Monthly Expenses
Total Monthly Income

* required

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Enter your loan officer here or leave blank if you are not currently working with someone.
Borrower Name:		Age:
Street Address:
City:	State:	Zip:
Home Phone:	Work Phone:
E-mail Address:
Co-Borrower Name:		Age:
Street Address:
City:	State:	Zip:
Home Phone:	Work Phone:

	Employer	How Long	Annual Salary	Avg. Annual Comm.	Total Annual Income
Borrower's:
Co-Borrower's:
Other Income (describe):

	Monthly Payments	Balance	Months Remaining
Current Mortgages	#1
	#2
Auto Loans	#1
	#2
	#3
Student Loans	#1
	#2
Child Support and/or Maintenance
Other Loans	#1
	#2
Credit Cards	#1
	#2

Money available for downpayment and closing costs and reserves.

1.		from sale of house
2.		gift
3.		savings
4.		other (describe)
Total