Name

Phone Number

Spouse's/Partners name (if applicable)

How long have you been at your present residence?

Do you own or rent?

How many years have you been at your present job?

How many years has your spouse/partner been on present job?

Your monthly income?

Your spouse's/partner's monthly income?

How much of your listed combined income is derived from overtime, bonus, or commission?

Amount of money you inttend to devote to this transaction?

Will this investment be derived from the sale of a home, savings, or gift? List each that applies.

Amount of monthly debts (do not include utilities, present rent, or mortgages that will be paid off at the time of purchase).

Are you or your spouse/partner a co-signer for any debt not listed above? If so, list monthly amount of obligation. If you and/or your spouse/partner are a co-signer for a loan, have you made any of the monthly payments in the last twelve months or has the loan been originated in the last twelve months?

Do you pay child support, alimony or maintenance? If so, please list the monthly amount.

Is the duration of any listed debt or obligation less than ten months? If less than ten months, list monthly amount.

Have you or your spouse/partner filed bankruptcy or had a home foreclosed upon in the last seven years?