Borrower Information

First Name, M.I., Last Name:

Address, City, State & Zip:

Social Security Number:

Date of Birth:

Work Phone:

Home Phone:

Email Address:

Co-Borrower Information

First Name, M.I., Last Name:

Address, City, State:

Social Security Number:

Date of Birth:

Work Phone:

Home Phone:

Email Address:

Desired Loan

Loan Type:

Loan Purpose:

Sales Price:

Loan Amount:

Down Payment:

Estimated Timeframe: 

Property Information

Property Type:

Occupancy:

Property Address:

Employement Information

Self Employed:

Years Employed:

Earnings, Liabilities, Assets:

Borrower

Co-Borrower

Annual Income: (Salary, Wages, Commission, Child Support Etc.)

Monthly Expenses: (Loans, Credit Cards, Child Support, Etc.)

Cash Available: (Checking, Savings, 401Ks, IRAs, Etc.)

As evidenced by my signatures, I/we acknowledge that we are not applying for a loan, and I/we give First Mortgage Group permission to order and review a report of my/our credit profile, and to share all information with prospective lenders.