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Borrower Name:
 Age:
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Home Phone:
 Work Phone:
  
E-mail Address:
Co-Borrower Name:
 Age:
Street Address:
City:
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Annual Income

  Employer How Long Annual Salary Avg. Annual Comm. Total Annual Income
Borrower’s:
Co-Borrower’s:
Other Income (describe):

Monthly Debt

  Monthly Payments Balance Months Remaining
Current Mortgages #1  
  #2  
Auto Loans #1
  #2
  #3
Student Loans #1
  #2
Child Support and/or Maintenance       
Other Loans #1
  #2
Credit Cards #1  
  #2  

Down Payment

Money available for downpayment and closing costs and reserves.
1. from sale of house
2. gift
3. savings
4. other (describe)
Total  


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