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Borrower Information Co-Borrower Information
Borrower First Name M.I. Last Name
SSN Date of Birth  
 
Street City State Zip
How Long Have You Been at Current Address Listed?
Do You Currently Own or Rent? Rent Own
Current rent or house payment
Home Phone Business Phone
ext

Mobile/Pager/Alternate Fax
 
Email Address  

Contact Me at Best Time to Call

Referred by

Loan Information

Loan Purpose Loan Type

Property Type

Will there be a co-borrower on this loan?
No Co Borrower Spouse Other

Purchase Price or Appraised Value for Refinance
$

Amount Avail for Down Payment or Closing Cost
$

Goals
Low Down Payment Cashout/Debt Consolidation Lower Interest Rate


Personal Information

Total Gross Yearly Income (Income Before Taxes)
$

Total Monthly Debt Payments (Including Alimony & Child Support)
$

Current Employer No.Years

Checking Account Balance $ Institution

Savings Account Balance $ Institution

Retirement Balance $ Institution

Do you authorize us to pull your credit report to pre-qualify you for a loan?
(If so please be sure to provide your social security number)
Yes No         Please Initial

Race

Ethnicity

Are you obligated to pay child support? Yes No

Comments



First Name M.I. Last Name
SSN Date of Birth  
 
Street City State Zip
How Long Have You Been at Current Address Listed?
Do You Currently Own or Rent? Rent Own
Current rent or house payment
Home Phone Business Phone
ext

Mobile/Pager/Alternate Fax
 
Email Address  

Contact Me at Best Time to Call

Referred by

Co-Borrower Personal Information

Total Gross Yearly Income (Income Before Taxes)
$

Total Monthly Debt Payments (Including Alimony & Child Support)
$

Current Employer No.Years

Checking Account Balance $ Institution

Savings Account Balance $ Institution

Retirement Balance $ Institution

Do you authorize us to pull your credit report to pre-qualify you for a loan?
(If so please be sure to provide your social security number)
Yes No         Please Initial

Race

Ethnicity

Are you obligated to pay child support? Yes No

Comments



 

 

 

 

8420 W. Dodge Rd. Ste 113 | Omaha, NE 68114 | 402-991-5153 | 800-519-1870 | Fax: 402-884-7386