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Purpose of Loan:	Purchase Refinance Construction Construction Permanent Other
Subject Property Address:
*Borrower* *Information*
Borrower's Name:
Home Phone:
Age:
Years School:
	Married	Separated
	Unmarried (includes single, divorced, widowed)
Present Address: (street, city, state, zip)
	Own Rent
Credit:	Excellent Good Fair Poor
Number of Years:
*Employment* *Information*
Name of Employer:
Address of Employer:
	Self-Employed
Position/Title/Type of Business
Business Phone:
Previous Employer:
Address of Employer:
	Self-Employed
Position/Title/Type of Business:
Business Phone:
Gross Monthly Income:
Are there any outstanding judgments against you?	Yes No
Have you been declared bankrupt within the last 7 years?	Yes No
Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?	Yes No
Is any part of the down payment borrowed?	Yes No
*Co-Borrower* *Information*
Borrower's Name
Home Phone:
Age:
Years School:
	Married Separated Unmarried (includes single, divorced, widowed)
Present Address: (street, city, state, zip)
	Own Rent
Number of Years:
Credit:	Excellent Good Fair Poor
*Co-Borrower* Employment *Information*
Name of Employer:
Address of Employer:
	Self-Employed
Position/Title/Type of Business
Business Phone:
Previous Employer:
Address of Employer:
	Self-Employed
Position/Title/Type of Business:
Business Phone:
Gross Monthly Income:
*Declarations*
Are there any outstanding judgments against you?	Yes No
Have you been declared bankrupt within the last 7 years?	Yes No
Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?	Yes No
Is any part of the down payment borrowed?	Yes No
Do you intend to occupy the property as your primary residence?	Yes No