Loan Officer Name *

First Name

Last Name

Borrower Name *

First Name

Last Name

Co Borrower Name

First Name

Last Name

Residency *

US Citizen

Permanent Resident Alien

Non Permanent Resident Alien

Foreign Nation

Has borrower(s) had any mortgage lates in past 12 months? *

Yes

No

Has borrower(s) had a CH 13 BK in last 12 months? *

Yes

No

Has borrower(s) had any other BKs in last 36 months? *

Yes

No

Has borrower(s) had any foreclosures in past 36 months? *

Yes

No

Property Address *

if unknown, put "TBD"

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Property Type *

PUD

SFR

Townhome

2-4 Unit

Condo

Non-Warrantable Condo

Estimated Closing Date

MM

DD

YYYY

Loan Purpose *

Purchase

Rate/Term Refinance

Cash Out Refinance

Loan Type *

3/1 ARM

5/1 ARM

7/1 ARM

15 YR FIX

30 YR FIX

Prepay Term *

Penalty is 6 months interest

60 Months

48 Months

36 Months (default)

24 Months

Interest Only *

Yes

No