Please fill in as much information as possible.

Phone: (305) 551-0407
Fax: (305) 228-0103

BORROWER PERSONAL INFORMATION
FULL NAME
ADDRESS
CITY, STATE, ZIP
HOME PHONE #
AGE
SOCIAL SECURITY NUMBER
MARITAL STATUS MARRIED SEPARATED UNMARRIED
NUMBER OF DEPENDENTS
AGES OF DEPENDENTS
EMPLOYMENT
WORK PHONE #
LENGTH OF TIME AT
PRESENT EMPLOYMENT
GROSS MONTHLY INCOME
CO-BORROWER PERSONAL INFORMATION
FULL NAME
ADDRESS
CITY, STATE, ZIP
HOME PHONE #
AGE
SOCIAL SECURITY NUMBER
MARITAL STATUS MARRIED SEPARATED UNMARRIED
NUMBER OF DEPENDENTS
AGES OF DEPENDENTS
EMPLOYMENT
WORK PHONE #
LENGTH OF TIME AT
PRESENT EMPLOYMENT
GROSS MONTHLY INCOME
BORROWERS CURRENT HOUSING INFORMATION
PRESENT ADDRESS
YEARS & MONTHS AT ADDRESS
RENT/MORTGAGE PAYMENT
MORTGAGE HOLDER OR
LANDLORD NAME
PHONE
PROPERTY INFORMATION
TYPE OF PROPERTY BEING BOUGHT OR REFINANCED
PURCHASE PRICE OR CURRENT LOAN AMOUNT
CASH ON HAND FOR PURCHASE
MAXIMUM AFFORDABLE MONTHLY PAYMENT
COMMENTS