| Applicant Information |
| First Name: |
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| Last Name: |
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| Date of Birth: |
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| Employment: |
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| Annual Income: |
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| Other Income + Source: |
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| Family Size: |
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| Address Street 1: |
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| Address Street 2: |
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| City: |
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| Zip Code: |
(5 digits) |
| State: |
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| Co-Applicant Information |
| First Name: |
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| Last Name: |
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| Date of Birth: |
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| Annual Income: |
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| Other Income + Source: |
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| Employment: |
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| Contact Information |
| Daytime Phone: |
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| Evening Phone: |
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| Email: |
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Loan Information
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| Are you currently working with a lender?: |
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| Are you currently working with a realtor?: |
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| Loan Type: |
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| Loan Amount: |
(USD) |
| Property Information |
| Property Type: |
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| Occupancy: |
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| Neighborhood Preference: Settegast, Sunnyside, Trinity Gardens, or Third Ward: |
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| Appraised Value: |
(USD) |
| Mortgage Balance: |
(USD if applicable) |
| Other Information |
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I authorize Chandra Dean to verify
my credit and employment history. |