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Borrower

DOB

Co-Borrower

DOB

Cell Phone

Work Phone

Address

City

Zip Code

Borrower Information

Employer

Self Employed

Title

Income

How Long?

Time in the same field

Prev. Employer

Self Employed

Title

Income

How Long?

Borrower FICO

Bankruptcy

Yes No

When?

Foreclosure?

Collections?

Co-Borrower Information

Employer

Self Employed

Title

Income

How Long?

Time in the same field

Prev. Employer

Self Employed

Title

Income

How Long?

Borrower FICO

Bankruptcy

Yes No

When?

Foreclosure?

Collections?

Total Liquid Assets?

Bank Assets?

Retirement Assets?

Other Cash?

Borrower: Years in School?

Co-Borrower: Years in School?

Dependents

Ages

Rent Payment

Years at Address

What hours are best for contact?

Is Text Msg ok?