General Information:

First Name                                 M.I.        Last Name 

	       


Street Address


City                                       State      Zip Code
    	

E-mail Address
 

 Home Phone


Work Phone 



Fax Number
 

Desired location of real estate to be purchased

Approximate sales price for your purchase property, if known.

Employment Information:

Borrower's Employer Name & Address:

How long employed here?

Co-Borrower's Employer Name & Address:

How long employed here?

Borrower's Gross Yearly Salary:                           

Co-Borrower's Gross Yearly Salary:                     
Other Income for Borrower? (Gross Yearly):       
Other Income for Co-Borrower? (Gross Yearly): 

Asset Information:

For this section, please only give approximate figures.

Savings:                

Checking:             

Money Markets: 

Future Savings:          

Mutual Funds:      

Stocks & Bonds:  

401K/Retirement Plans:          

Any other assets you feel are applicable:

Are any of the above stated funds not to be used for purchase of new real estate?

Do you have any potential gift monies from any source?
YES
NO
If YES, what would the amount be?

Debt Information:

The following debt information is a critical aspect of this financial analysis. We will give you several general categories of possible revolving debt to fill in. These may not be all-inclusive, so please use the 'other' section to include your unique situation. Revolving debt is defined as any constant, monthly payments you make, whether amortized or not. (ie: car payments, home equity loan, school loans, credit cards...)

Please give both the current total balance of the debt as well as the current monthly payment.

Type of Account                 Current Balance     Monthly Payment

Combined Credit Cards: 

Car Loans:                        

School Loans:                              
Personal Loans:               

Please continue with any other revolving debts you may have that do not fit in the categories listed above:

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Do you currently own or rent?
OWN
RENT
If OWN, will you be selling this property prior to buying the new property?
YES
NO

If you are selling/or will sell this property prior to your new purchase, what will the proceeds equal?

If you are not selling this property, what will your total monthly cost be to maintain it (ie: loan payments, taxes & insurance)?

If you own a second or third home please give the same type of info below:

Disclosure Information:

Will you occupy the new premises?
YES
NO

Have you in the last 7 years declared bankruptcy, suffered foreclosure, had an account assigned for collection or had any legal action affecting your ability to finance?
YES
NO
If, YES, explain below:

Is any part of the purchase price or settlement cost being obtained from a source other than shown?
YES
NO

If you answered "YES" and the money in question is other than monies mentioned in the gift section above, please describe below:

I also filled in the search/referral form!
I did not fill in the search/referral form!

Thank you for taking the time to review and complete this form. We at RE/SOURCE Inc. believe it will be an excellent start in acquiring your new home. Simply click on the "submit request" button below to continue.