| Your
Name * |
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| Company
Name |
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| E-mail
Address * |
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| Contact# |
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| Fax# |
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| Property
Address |
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| City |
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| State |
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| Zip
Code |
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| Name
Of Borrower |
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| SSN
Of Borrower |
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| Name
Of Co-Borrower |
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| SSN
Of Co-Borrower |
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| Marital
Status of Borrowers |
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| Borrower's
Address |
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| B
City |
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| B
State |
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| Borrower's
Contact # |
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| Primary
Residence |
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Yes
No |
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| Refinance
or Purchase and Sale? |
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| Purchase
Price |
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| Loan
Amount |
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| Name
of Proposed Lender |
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| Name
of Loan Officer / Processor |
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| Lender
Contact # |
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| Estimated
Closing Date |
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| Name
of Seller |
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| SSN
of Seller |
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| Name
of Co-Seller |
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| SSN
of Co-Seller |
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| Marital
Status of Sellers |
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| Seller's
Address |
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| S
City |
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| S
State |
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| S
ZIP Code |
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| Seller's
Contact # |
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| First
Mortgage Holder |
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| Loan
# for First Mortgage |
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| Second
Mortgage Holder |
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| Loan
# for Second Mortgage |
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| Does
a Boundary Survey need to be ordered?
Yes or No |
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Yes
No |
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| Does
a Termite Inspection need to be ordered?
Yes or No |
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Yes
No |
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Is there a Condo or Homeowner's Association?
Yes or No |
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Yes
No |
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| Name
of Association |
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| Contact
# for Association |
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| Name
of Hazard Insurance Company |
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| Contact
# for Insurance Company |
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| Additional
Comments |
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