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Applicant's Information

First Name *	MI	Last Name *
E-Mail *
Phone *		Cell
Birth Date *	Social Security # *
Down Payment Amount (to secure loan )* $

Primary Residence

Address Line 1 *
Address Line 2
City *	State * Postal Code *

Amount of Time at this Residence: Years Months

Own Rent Other

Total monthly housing payment $
Total years as a homeowner

Previous Residence
(If less than 2 years at current residence)

Mailing Address
(If different than primary address)

Current Employment

Occupation *	Employer *
Work Phone
Self-Employed?	Yes No
Gross Monthly Income * $	Monthly
How long employed by this employer? * Years Months
Address Line 1
Address Line 2
City *	State Postal Code

Previous Employment
(If less than 2 years at current employment)

Please Check * I, the Applicant, certify that all of the statements in this application are true and complete and are made for the purpose of obtaining credit.

Do you Have a Co-Applicant? (co-buyer, co-signer) Yes No

Co-Applicant's Information (to be filled out by the co-applicant)

First Name	MI	Last Name
E-Mail	Phone		Fax
Birth Date	Social Security #

Primary Residence

Address Line 1
Address Line 2
City	State Postal Code

Amount of Time at this Residence: Years Months

Own Rent Other

Total monthly housing payment $
Total years as a homeowner

Previous Residence
(If less than 2 years at current residence)

Mailing Address
(If different than primary address)

Current Employment

Occupation	Employer
Work Phone
Self-Employed?	Yes No
Gross Monthly Income $	Monthly
How long employed by this employer? Years Months
Address Line 1
Address Line 2
City	State Postal Code

Previous Employment
(If less than 2 years at current employment)

Please Check I, the Co-Applicant, certify that all of the statements in this application are true and complete and are made for the purpose of obtaining credit.

Do you have a vehicle you plan to trade in? Yes No

Where did you hear about us?

Questions / Comments?

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