First Name * Last Name * Phone Number * Email Address * Current Address * Address2 City/State/Zip * How long at current address? Own or Rent? Own Rent Current Mo. Housing Expense Current Employer Employer's Address City/State/Zip * Work Phone Number How Long at Current Job? Wage Type Self Employed W2 Stated Income No Doc Yearly Gross Income Avg Monthly Liabilities Avg Monthly Checking Balance Avg Monthly Savings Balance Loan Purpose Purchase Refinance Cash-Out Refinance Loan Program 30 yr fixed 20 yr fixed 15 yr fixed 2 yr ARM 3 yr ARM 5 yr ARM 30 yr fixed Interest only 5 yr ARM Interest only Property Type Single Family Residence Multi-Family Residence Condo Town-house Modular Manufactured Occupancy Type Primary Residence Second Home Investment Comments