Borrower General Information

Borrower Full Name *

Borrower Phone *

Borrower Email *

Co-Borrower Full Name

Co-Borrower Phone

Co-Borrower Email

Reason for considering a refinance *

Lower Current Rate

Cash Out to Consolidate Debt

Cash Out to Repair/Renovate/Remodel Home

Other

If Cash Out - Desired Amount of Cash Out

Borrower Estimated credit score *

Co-Borrower Estimated Credit Score

Property Information

Property Street Address *

City *

State *

Postal code *

Type of property your refinancing *

Primary Residence

Second Home

Investment Property

Date of Occupancy *

Estimated Home Value *

Current Interest Rate *

Current Mortgage Balance *

Current mortgage payment *

Mortgage Lates In The Last 24 Months (30+ days) *

Yes

Income Information

Borrower Job Title: *

Borrower Gross Monthly Income (before taxes) *

Borrower Length of Employment? (years) *

Co-Borrower Job Title

Co-Borrower Gross Monthly Income (Before Taxes)

Co-Borrower Length of Employment (Years)

Monthly Payments Information

Provide combined totals for both borrower and co-borrower

Enter "0" for any fields that do not apply.

Auto Loan Balance *

Monthly Auto Loan Payments *

Total Credit Card Debt *

Total Monthly Credit Card Minimum Payments *

Total Student Loan Debt *

Monthly Student Loan Payments *

Monthly Child Support / Alimony Payments *

Total Liens / Judgments *

Declarations

If you answer "Yes" to any questions 1-5, please submit a full explanation with your other document submissions.

1. Are there any outstanding judgements against you? *

Yes

2. Have you declared bankruptcy in the past 7 years? *

Yes

3. Have you had Property foreclosed upon on in the past 7 years? *

Yes

4. Are you a party to a current lawsuit? *

Yes

5. Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond or loan guarantee? *

Yes

Marital Status *

Married

Single

Separated

Additional Information

Referral Information

As I continue to grow my business, I’d really appreciate knowing how you found me, it helps me understand what’s working and how to better serve future clients.

Referrer's Name

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