********** Borrower Information Borrower Full Name * Borrower SSN * Borrower D.O.B. * Borrower Marital Status * Married Single Seperated Borrower Credit (Self Evaluation) * 1 2 3 4 5 6 7 8 9 10 Bankruptcy, Foreclosure or Short Sale in the past 4 years? * No Yes Borrower Home Phone # * Borrower Office/Work Phone # * Borrower Cellular Phone # Borrower Email * Borrower Current Address * Borrower Current Address 2 Borrower City * Borrower State * Borrower Zipcode * Borrower Current Residence * Rent Own Current Payment * Years at Current Address * Previous Address (if under 2 years) ********** Home Being Purchased Address of Home * Address of Home 2 * City * State * Zipcode * Mobile Home Park * Home Manufacturer / Model Dimensions / Size Serial Number Year Built * Space Rent * Purchase Price * Down Payment * ********** Borrower's Income Borrower Employer * Employer Address * Employer Address 2 City * State * Zipcode * Position with Company * Years with Company * Previous Employer Is Borrower Self Employed? * Yes No Borrower Monthly Income * Borrower Social Security Borrower Pension Borrower Other Income Borrower Other Income Description Checking Account Bank * Checking account Balance * Savings Account Bank Savings Account Balance Borrower Retirement Company Borrower Retirement Balance Borrower Other Account Type (1) --- Checking Savings Retirement Other Borrower Other Account Bank (1) Borrower Other Account Balance (1) Borrower Other Account Type (2) --- Checking Savings Retirement Other Borrower Other Account Bank (2) Borrower Other Account Balance (2) Automobile Owned - Year/Make/Model (1) Automobile Owned - Year/Make/Model (2) . ********** Co-Borrower Information If no Co-Borrower, go to the bottom and click "Send" Co-Borrower Full Name Co-Borrower SSN Co-Borrower D.O.B. Bankruptcy in the past 4 years? No Yes Co-Borrower Employer Employer Address Employer Phone Position with Company Is Co-Borrower Self-Employed? No Yes Gross Income Social Security Pension Income Co-Borrower Other Income Co-Borrower Other Income Description Checking Account Bank Checking Account Balance Savings Account Bank Savings Account Balance Retirement Account Company Retirement Amount Co-Borrower Other Account Type (1) --- Checking Savings Retirement Other Co-Borrower Other Account Bank (1) Co-Borrower Other Account Balance (1) Co-Borrower Other Account Type (2) --- Checking Savings Retirement Other Borrower Other Account Bank (2) Co-Borrower Other Account Balance (2) Accept Terms of Application (hover red question mark to view terms) *