Residential Loan Application

Borrower Information

Name

Address

City

State

Zip Code

Home Phone

Work Phone

Email

Please contact me by
EmailHome PhoneWork Phone

Best Time to Reach me
Morning 10:00 AM to 11:00 AMAfter Noon 12:00 PM to 18:00 PMEvening 18:00 PM to 20:00 PM

Occupation

Annual Income
Less than $25,000$25,000 to 50,000$50,000 to 75,000$100,000 to 150,000$150,000 to 250,000$250,000 to 500,000more than $500,000

Credit Status
more than 800799 to 700699 to 600599 to 500499 to 400In BankruptcyBankruptcy discharged within 3 yearsOther I will explain in comment area

Existing First Trust Deed

Current or Past due
CurrentPast due

Monthly Payment

Interest Rate

Original Balance $

Present Balance (if none type “0”) $

Term

Existing Second Trust Deed

Current Past due
CurrentPast due

Interest Rate

Monthly Payment $

Original Balance $

Present Balance $

Term

Loan Quote Request

Amount of Cash Down Payment (if purchase)

Amount of Loan Requested

Amount of Seller Carryback (if applicable)

Additional Information / Comments

Purpose of Loan
PurchaseMaturing Loan – No Cash outMaturing Loan — Cash outCash out RefinanceRennovation or expansionInvestmentBillsBusiness PurposesOther

Requested Loan Type
First MortgageSecond MortgageThird Mortgage

Term Desired
1 Year2 Year3 Year4 Year5 Year6 Year7 Year8 Year9 Year10 Year