Section 1 : Borrower Information

Please tell us about your personal information and your income from your employment and other sources, such as retirement, that you want to be considered to qualify for this loan.

Section 1a- Personal Information

(1a.1)- Name ( First, Middle Last, Suffix): ___________    ___________     ___________   _________


(1a.2)- Alternative Names: List any names by which you are known or any names under which credit was previously received ____________________________________________________________________________


(1a.3)- Social Security Number or Individual Taxpayer Identification Number ___  __ ____ (Three boxes to enter nine digits in sequence of three followed by two and then followed by four digits )


(1a.4)- Date of Birth: (mm-dd-yyyy) -- / --/ ---- (drop down for day, month and year)


(1a.5)- Citizenship: US Citizen, Permanent Resident Alien, or non Permanent Resident Alien (Check Boxes for three options to select only one)


(1a.6)- I am applying for Individual credit or Joint Credit: (Drop down for Individual Credit or Joint Credit) If Individual Credit selected, no change, if Joint Credit selected, next question should be, select number of borrowers with a drop down menu for upto six borrowers. Four Rows for each name equal to the number of columns selected for number of borrowers. Example three  borrowers selected, should have the following in sequence  (First, Middle Last, Suffix)

-------------------          ---------------------    -------------------   ------------------
-------------------          ---------------------    -------------------   ------------------
-------------------          ---------------------    -------------------   ------------------


(1a.7)- Marital Status: Three check boxes for "Married, Seperated, Unmarried" -  

If Unmarried,  is there a person who is not your legal spouse but who currently has real property rights similar to  those of a legal spouse?        NO YES N/A  (Three check boxes)

If YES, indicate the type of relationship and the State in which the relationship was formed.  For example, indicate if you are in a civil union, domestic partnership, registered reciprocal beneficiary relationship, or other relationship recognized by the State in which you currently reside or where the property is located.

(check boxes for the following five options) 
NA   Civil Union    Domestic Partnership Registered Reciprocal Beneficiary Relationship Other (explain) ____________
State: Drop down for fifty states 


(1a.8)- Contact Information: 
Home Phone  (---)  ---  ----
Cell Phone:     (---)  ---  ----
Work Phone   (---)  ---  ----
Email ----------------------------------


(1a.9)- Current Address: 
Street -----------------------------------------------------------------   Unit # ------
City ---------------------- State: Drop Down: -------      Zip -----    Country --------
How long at Current Address: Years (drop down) Months (Drop Down)

Housing
Check Box grid for three options -     No Housing Expense,  Own,  Rent ($------- / month)



(1a.10)- If at current address less than  2 years, list former address    or check box Does not Apply
Street ---------------------------------------------------------------- Unit # ---------
City --------------------- State "Drop Down for States" -------  Zip -------- Country ----------
How Long at Former Address? ----- Years  ----- Months

Housing
Check Box grid for three options -     No Housing Expense,  Own,  Rent ($------- / month)


(1a.11)- Mailing Address
Street ---------------------------------------------------------------- Unit # ---------
City --------------------- State "Drop Down for States" -------  Zip -------- Country ----------




1b- Current Employment / Self Employment and Income     Check Box for "Does Not Apply"

(1b.1)- Employer or Business Name --------------------------------- Phone (---) ---- --------
Street ------------------------------------------------ Unit # ----------------
City -------------------------- State ---------- Zip --------- Country -----------

Position or Title -----------------------------  Start Date ----- / ------ / --------- (mm/dd/yyyy)
How Long in this line of work? ----- Years  ----- Months

Check if this statement applies:  (check Box) I am employed by a family member, property seller, real estate agent, or other party to the transaction

Check if you are the Business Owner or Self Employed (Check Box)
Check if you have ownership share of less than 25% (Check Box)
Check if you have ownership share of 25% or more (Check Box)

Monthly Income or Loss $ -------------


1b.2- Your Current Gross Monthly Income

Base   $-------------------- / month
Overtime   $------------------ / month
Bonus   $------------------- / month
Commission   $-------------- / month
Military Entitlements   $------------------- / month
Other   $------------------ / month

Total $ ----------------- / month (sum of above)


1c- If APPLICABLE, Complete Information for Additional Employment / Self-Employment and Income      "Check box" for Does not Apply"


(1c.1)- Employer or Business Name --------------------------------- Phone (---) ---- --------
Street ------------------------------------------------ Unit # ----------------
City -------------------------- State ---------- Zip --------- Country -----------

Position or Title -----------------------------  Start Date ----- / ------ / --------- (mm/dd/yyyy)
How Long in this line of work? ----- Years  ----- Months

Check if this statement applies:  (check Box) I am employed by a family member, property seller, real estate agent, or other party to the transaction

Check if you are the Business Owner or Self Employed (Check Box)
Check if you have ownership share of less than 25% (Check Box)
Check if you have ownership share of 25% or more (Check Box)

Monthly Income or Loss $ -------------


1c.2- Your Current Gross Monthly Income

Base   $-------------------- / month
Overtime   $------------------ / month
Bonus   $------------------- / month
Commission   $-------------- / month
Military Entitlements   $------------------- / month
Other   $------------------ / month

Total $ ----------------- / month (sum of above)



(Provide at least 2 years of current and previous employment and Income)
1d- If Applicable, Complete Information for Previous Employment / Self Employment and Income 
"Check box" for Does not Apply"


1d.1- Employer or Business Name --------------------------------- Phone (---) ---- --------
Street ------------------------------------------------ Unit # ----------------
City -------------------------- State ---------- Zip --------- Country -----------

Position or Title -----------------------------  Start Date ----- / ------ / --------- (mm/dd/yyyy)
End Date   ----- / ------ / --------- (mm/dd/yyyy)

(check Box) If you were the Business owner or Self Employed



1d.2- Previous Gross Monthly Income $-------------------- / month



1e- Income from Other Sources     Does Not Apply "Check Box"

Three Drop Down Menu with the following 22 Options -


NOTE: Reveal alimony, child support, separate maintenance, or other income ONLY IF you want it considered in determining your qualification for this loan


Alimony  •   Automobile Allowance  •   Boarder Income  •   Capital Gains  •   Child Support  •   Disability  •   Foster Care  •   Housing or Parsonage  •   Interest and Dividends  •   Mortgage Credit Certificate  •   Mortgage Differential Payments  •   Notes Receivable  •   Public Assistance  •   Retirement (e.g., Pension, IRA)  •   Royalty Payments  •   Separate Maintenance  •   Social Security  •   Trust  •   Unemployment Benefits  •   VA Compensation  • Other

Income Source - use list Below                                                    Monthly Income
Drop Down Menu with the Above 22 Options --                                    ________________

Drop Down Menu with the Above 122 Options --                                  ________________

Drop Down Menu with the Above 22 Options --                                    ________________

Total Amount                                                                                           (Sum of above)












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