How did you hear about us?__________________________
Applicant:
_________________________________________________________________
Name
Home Phone Number: (________) _________________________ Cell Phone: (________) _________________________
Work Phone Number: (________) _________________________ Cell Phone: (________) _________________________
SS#:______________________________________ DOB: ____________________________________
Current Address:
___________________________________________________________
___________________________________________________________
How Long? _________ OWN or RENT? Monthly Payment: $________________
Co-Applicant:
___________________________________________________________________
Name
Home Phone Number: (________) _________________________ Cell Phone: (________) _________________________
Work Phone Number: (________) _________________________ Cell Phone: (________) _________________________
SS#:______________________________________ DOB: ____________________________________
Current Address:
___________________________________________________________
___________________________________________________________
How Long? _________ OWN or RENT? Monthly Payment: $________________
EMPLOYMENT HISTORY:
APPLICANT FIRST:
Current Employer: ________________________________________________________________________________
Your Title/Job Description: ________________________________________ How Long There?________________
YR 2003 Gross? $________________/YR YTD Gross 2002: $_______________
Current Gross Pay: $ ___________________/per YR MO WK HOUR
OT Available? Y N - How long since last raise? __________
Other Income with Description: ________________________________________________________________________
CO-APPLICANT:
Current Employer: ________________________________________________________________________________
Your Title/Job Description: ________________________________________ How Long There?________________
YR 2003 Gross? $________________/YR YTD Gross 2002: $_______________
Current Gross Pay: $ ___________________/per YR MO WK HOUR
OT Available? Y N - How long since last raise? __________
Other Income with Description: ________________________________________________________________________
RENTAL HISTORY:
Rent Amount $ __________________ Pd By: Check MO CASH
How Long with current landlord? ____________________________
Receipts Available for last 12 Months? _______________________
Could We Use As A Good Reference? ________________________
OTHER INFORMATION:
Taxes Filed in the last 2 years? Y____ N____
First Time Home Buyer? Y____ N____
Receive Child Support? Y____ N____ $_________________
Pay Child Support? Y____ N____ $_________________
Co-Signer Available? Y____ N____
Ever Filed Bankruptcy? Y____ N____ When Filed: _______ Discharged When? ____________
FUNDS AVAILABLE ON HAND: (Must be completed)
*Very Important For Purchase Pre-Qualification*
Savings: $_______________ Checking: $_________________
401K: $_______________ IRA: $_________________
Gift $_______________ Other: $_________________
Notes/questions/things you want us to know: _________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
________________________________ ______________
Signature 0f Applicant: Date:
________________________________ ______________
Signature of Co-Applicant: Date: