Date:                                    Loan Officer:  (We'll fill in this blank)

 Borrowers Objectives: 

 Borrower:            SS# 

 Co-Borrower:       SS# 

 Present Address: 

 Subject Property:       County:  Sarasota Manatee Charlotte Desoto Hillsborough Pinellas Collier Lee

 Home Phone #:            Cell Phone #: 

Current Mortgage Information

 Approx. Home Value:            Date Purchased: 

 Who holds the first mortgage?:    Balance: 

 Monthly Payment:    Current Annual Taxes: 

 Annual Homeowners Insurance:     Monthly Mortgage Insurance: 

 Interest Rate:  %     Fixed   Adjustable    Term: 

 Type of Loan:   Conventional FHA / VA Private Other     If other: 

 2nd Mortgage:  Yes  No      If "Yes", with who: 

 2nd Mortgage balance:    Payment:    Rate:  %     Term: 

 Employment History

 Borrower Employer:    Employer Phone #: 

 How long:    Position:    Gross Monthly $:

 Co-Borrower Employer:    Employer Phone #: 

 How Long:    Position:    Gross Monthly $: 

If less than 2 year history: 

Dates of prior employment:    thru:    Gross Monthly $: 

Any other income source(s):    Amount of other income: 

Savings/Investments or Other Assets including other real estate: 

 Customer Comments:

Equal Housing Lender. © 2003 Money Consultants, Inc.  Approvals are  subject to satisfactory appraisal and title review and no change in financial condition. If your rate is not locked or rate protection expires, any rate increases may lower your approved loan amount. Refinancing or taking out a home equity loan  may increase the total number of monthly payments and the total amount paid when comparing to your current situation.