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Your name
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Interest Rate:
Subject Property Address (street, city, state, & ZIP):
No. of Units:
Legal Description of Subject Property (attach description if necessary):
Year Built:
Year Lot Acquired:
Original Cost:
Amount of Existing Liens:
Present Value of Lot:
Cost of Improvements:
Year Acquired (for refinance loan):
Original Cost (for refinance loan):
Amount of Existing Liens (for refinance loan):
Purpose of Refinance - Describe Improvements:
Source of Down Payment, Settlement Charges, and/or Subordinate Financing (explain):
Mailing Address (if different from Present Address):
Years Employed in this Line of Work/Profession:
Position/Title/Type of Business:
Business Phone (including area code):
Monthly Income:
Cash or Market Value
Cash deposit toward purchase held by: $
List checking and savings accounts below
Name and address of Bank, S&L, or Credit Union
Acct. no.
Name and address of Bank, S&L, or Credit Union
Acct. no.
Name and address of Bank, S&L, or Credit Union
Acct. no.
Name and address of Bank, S&L, or Credit Union
Acct. no.
Stocks & Bonds (Company name/number & description)
Life insurance net cash value
Face amount: $
Subtotal Liquid Assets $
Real estate owned (enter market value from schedule of real estate owned)
Vested interest in retirement fund
Net worth of business(es) owned (attach financial statement)
Automobiles owned (make and year) $
Other Assets (itemize) $
Total Assets a. $
Name and address of Company $ Payment/Months $
Acct. no.
Name and address of Company $ Payment/Months $
Acct. no.
Name and address of Company $ Payment/Months $
Acct. no.
Name and address of Company $ Payment/Months $
Acct. no.
Name and address of Company $ Payment/Months $
Acct. no.
Name and address of Company $ Payment/Months $
Acct. no.
Name and address of Company $ Payment/Months $
Acct. no.
Alimony/Child Support/Separate Maintenance Payments Owed to: $
Job-Related Expense (child care, union dues, etc.) $
Total Monthly Payments $
Net Worth (a minus b) ➧ $ Total Liabilities b. $
VI. ASSETS AND LIABILITIES (cont.)
Schedule of Real Estate Owned (If additional properties are owned, use continuation sheet.) Insurance, Property Address (enter S if sold, PS if pending sale or R if rental being held for income)
Type of Property
Present Market Value
Amount of Mortgages & Liens
Gross Rental Income
Mortgage Payments
Maintenance, Taxes & Misc.
Net Rental Income
Totals
Totals
List any additional names under which credit has previously been received and indicate appropriate creditor name(s) and account number(s):
Alternate Name
Creditor Name
Account Number
VII. DETAILS OF TRANSACTION VIII. DECLARATIONS
Purchase price $
a. Alterations, improvements, repairs
b. Land (if acquired separately)
c. Refinance (including debts to be paid off)
d. Estimated prepaid items
e. Estimated closing costs
f. PMI, MIP, Funding Fee
g. Discount (if Borrower will pay)
h. Total costs (add items a through h)
i. Subordinate financing
j. Borrower's closing costs paid by Seller
k. Other Credits (explain)
l. Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee?
m. Are you obligated to pay alimony, child support, or separate maintenance?
n. Loan amount (exclude PMI, MIP, Funding Fee financed)
o. Is any part of the down payment borrowed?
p. Are you a co-maker or endorser on a note?
Cash from/to Borrower (subtract j, k, l & o from i)
(1) What type of property did you own—principal residence (PR), second home (SH), or investment property (IP)?
(2) How did you hold title to the home—solely by yourself (S), jointly with your spouse (SP), or jointly with another person (O)?
Submit