Form Mail Script

Applicant(s) Contact Information:


Applicant First Name

E-Mail

Applicant Last Name

Work Phone

Home Phone


Co-Applicant First Name

E-Mail

Co-Applicant Last Name

Work Phone

Home Phone


Address

State

City

Zip

 

Gross Income:


Applicant Employer

Monthly Income Amt.
$

Position

Years on Job

Years in same field


Co-Applicant Employer

Monthly Income Amt.
$

Position

Years on Job

Years in same field

Other Income Applicant

Monthly Income Amt

Other Income Co-Applicant

Total Gross Monthly Income:

 

Assets


Checking and Savings Accounts

Amount
$

Financial Institution

 

Financial Institution

Amount
$

Stocks and Bonds (Please Describe)

Amount
$

$

$

Life Insurance

Face Amount
$

 

 

Automobile Type

Est. Value
$ Yr.

$ Yr.

   
   

Other Assets (Please Describe)

Amount
$

 

Housing Expenses:


     

Monthly Payment

1st Mortgage

   

$

Property Taxes

   

$

Home Owners Insurance

   

$


Monthly Credit Card Debts:


Account Name

Cur. Bal.

Monthly Payment

$

$

$

$

$

$


Type of Loan Requested:


Loan Type: 

Residence Type: 

Property Type: 

Loan Terms: 

Estimated Loan Amount: 

$

 


The best time to contact me 

 would be: 

around: 

:

by: 

Comments: 

 

 

 

 

 

 

 

 

* = Required fields

 

 

 

 

 

 

Private Krankenversicherung (PKV)