Borrower 1
Borrower 2
Dr.
Mr.
Mrs.
Ms.
Miss.
Dr.
Mr.
Mrs.
Ms.
Miss.
(optional)
First name
M.I.
(optional)
First name
M.I.
Jr.
Sr.
Jr.
Sr.
Last name
(optional)
Last name
(optional)
-
-
-
-
-
-
-
-
Home phone
Business phone
Home phone
Business phone
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Dec
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Jan
Feb
Mar
April
May
June
July
Aug
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Oct
Nov
Dec
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Birthdate (Month/DD/YYYY)
Birthdate (Month/DD/YYYY)
Select status
Married
Unmarried
Legally Separated
Select status
Married
Unmarried
Legally Separated
Marital status
Marital status
E-mail address
E-mail address
-
-
-
-
Social security number
Social security number
Citizenship status
U.S citizen
Permanent resident alien
Other
Citizenship status
U.S citizen
Permanent resident alien
Other
Citizenship
Citizenship
Current Home Information
Current Home Information
Rent
Own
None of these
Rent
Own
None of these
When did your customer move to this address? (Month/YYYY)
When did your customer move to this address? (Month/YYYY)
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Jan
Feb
Mar
April
May
June
July
Aug
Sept
Oct
Nov
Dec
/
--
Jan
Feb
Mar
April
May
June
July
Aug
Sept
Oct
Nov
Dec
/
Address
Does Borrower #2 live at the same address? If so check here
and skip to purpose of loan.
Number
Street Name
Number
Street Name
Unit #
City
city listing
Unit #
City
city listing
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AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
--
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
State
Zip code
State
Zip code
What is the purpose of the loan?
PurchaseBorrower has selected a property and signed a sales agreement
PurchaseBorrower has not decided on a property yet
Refinance