Mortgage Information
Loan Purpose	Purchase Refinance Home Equity	Home Value
Property Type	Primary Residence Second Home Investment	Loan Amount
Loan Type	30 Year Fixed 15 Year Fixed Jumbo 30 Year Fixed Jumbo 15 Year Fixed FHA 30 Year Fixed FHA 1 Year ARM 1 Year ARM 3/1 ARM 5/1 ARM	Equity/Down Payment
Estimated Closing Time	Immediately Within 1 Month Within 2 months More than 3 months	Contact me by		Phone E-mail
Property Address		Best Time To Reach		Morning Afternoon Evening
City, State
Zip Code
Borrower Information
Borrower		CO-Borrower
Full Name		Full Name
Address		Address
City, State		City, State
Zip Code		Zip Code
Home Phone		Home Phone
Work Phone		Work Phone
E-mail		E-mail
Social Security		Social Security
Employers		Employers
Phone Number		Phone Number
Employment	More Than 2 YRS Less Than 2 YRS Self Employed > 2 YRS Self Employed < 2 YRS	Employment		More Than 2 YRS Less Than 2 YRS Self Employed > 2 YRS Self Employed < 2 YRS
Gross Monthly Income		Gross Monthly Income
Date of Birth		Date of Birth
My credit history is:	Exellent Good, but some lates some credit problems major credit problems don't know		Exellent Good, but some lates some credit problems major credit problems don't know
Loan Type	Creditors	Amount Owed		Monthly Payment	Will you pay this off?
Mtg Auto Loan Card Other					yes no
Mtg Auto Loan Card Other					yes no
Mtg Auto Loan Card Other					yes no
Mtg Auto Loan Card Other					yes no
Mtg Auto Loan Card Other					yes no
Mtg Auto Loan Card Other					yes no
Mtg Auto Loan Card Other					yes no
Mtg Auto Loan Card Other					yes no
Other Information
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License # 5498 State of Illinois Office of Banks and Real Estate 310 S. Michigan Chicago, IL. 60604 (312) 793-3000