Borrower Information-This is an example of a typical mortgage application.
Borrower Name:
Social Security#:
Date of Birth: (mm/dd/yy)
Street Address:
City:
State:
Zip:
How long have you been at the above address?
Do you own or rent this property?
If less than 2 years at above address, please input your previous address and how long you live
there:
Home Phone Number:
Work Phone Number:
Race/National Origin :
If other, please specify:
E-mail Address:
Marital Status:
Years of School:
Co-Borrower Information
Co-Borrower Name:
Social Security#:
Date of Birth: (mm/dd/yy)
Street Address:
City:
State:
Zip:
How long have you been at the above address?
Do you own or rent this property?
If less than 2 years at above address, please input your previous address and how long you live
there:
Home Phone Number:
Work Phone Number:
Race/National Origin :
If other, please specify:
E-mail Address:
Marital Status:
Years of School:
Borrower Employment Information
Company Name:
Company Address:
Job Title:
Dates of Employment:(mm/dd/yy)
to present
Annual Salary:
If less than 2 yrs in current position, please list the following info from your previous
employer:
Company Name:
Title:
Dates of Employment:(mm/dd/yy) to
Income:
$
Type of business:
Address of previous company:
Co-Borrower Employment Information
Company Name:
Company Address:
Job Title:
Dates of Employment:(mm/dd/yy)
to present
Annual Salary:
If less than 2 yrs in current position, please list the following info from your previous
employer:
Company Name:
Title:
Dates of Employment:(mm/dd/yy) to
Income:
$
Type of business:
Address of previous company:
Monthly Income and Combined Housing Expense Information
Gross Monthly Income
Borrower
Co-
Borrower
Total
Combined
Monthly
Housing
Expense
Present
Base Employment Income*
$
$
$
Rent
$
Overtime
$
$
$
1st Mort. (P & l)
$
Bonuses
$
$
$
Other Financing
$
Commissions
$
$
$
Hazard Insurance
$
Dividends/Interest
$
$
$
Real Estate Taxes
$
Net Rental Income
$
$
$
Mortgage Insurance
$
Other
$
$
$
Other
$
TOTAL
$
$
$
TOTAL
$
*Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial
statements.
Describe Other Income Notice: Alimony, Child Support, or separate maintenance income need to be revealed if the Borrower (B)
or Co-Borrower (C) does not choose to have it considered for repaying this loan.
B/C
Monthly Amount
Assets and Liabilities
This Statement and any applicable supporting schedules may be completed jointly by both married
and unmarried Co-Borrowers if their assets and liabilities are sufficiently joined so that the Statement
can be meaningfully and fairly presented on a combined basis; otherwise separate Statements and Schedules
are required. If spouse completed the Co-Borrower section, this Statement and supporting schedules must be
completed about that spouse also.