General Information:

BORROWER

first name                                 m.i.        last name 

	       

street address

city                                       state      zip code
    	

e-mail address

home phone 

work phone 


CO-BORROWER

first name                                 m.i.        last name 

	       

street address

city                                       state      zip code
    	

e-mail address
 
home phone 

work phone 

Desired location of real estate to be purchased
LocationState

Approximate sales price for your desired property

Do you already have a property in mind to purchase?
Yes No

Employment Information:

Borrower's Employer Name & Address:

Position:                              

Dates employed here:   to 

Gross  Monthly Salary:                          

Co-Borrower's Employer Name & Address:

Position:                              
Dates employed here:   to 

Gross  Monthly Salary:                          

Please complete this section if you have been with your current employer for less than 2 years:

Borrower's Previous Employer Name & Address:

Position:                              

Dates employed here:   to 

Gross  Monthly Salary:                          

Co-Borrower's Previous Employer Name & Address:


Position:                              
HDates employed here:   to 

Gross  Monthly Salary:                          

Please complete this section for a 2nd job or additional employers

Borrower's Second Employer Name & Address:

Position:                              

Dates employed here:   to 

Gross  Monthly Salary:                          

Co-Borrower's Second Employer Name & Address:


Position:                              
Dates employed here:   to 

Gross  Monthly Salary:                          

Do you have any Self Employment Income ? Yes No

Asset Information:

For this section, please only give approximate figures in each account area. There is no need to give account numbers or names of the institutions in which the monies reside.

Savings:                

Checking:             

Money Markets: 

401K Plans:          

Mutual Funds:      

Stocks & Bonds:  

Any other liquid 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 a family member.
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. (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                 Approx. Balance     Monthly Payment

Combined Credit Cards: 

Car Loan:                         

Car Loan:                          

School Loan:                    

School Loan:                                           

Personal Loans:               

1st Mortgage                    

2nd Mortgage                  

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

Have you ever been previously married?
YES
NO
If ,YES, is there any allimony/child support payment, and how much on a monthly basis?
How long will payments continue ?

---

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 are selling/or will sell this property prior to your new purchase, what will the approximate net 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 will be renting the property, how much do you expect for rent?

If you own a second or third home please give the same info for them in the space provided 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:

Are you a US citizen ?
YES
NO

If NO, are you a US Resident Alien?
YES
NO

Do you have Vetern status ?
YES
NO

If YES, are you a reservist?
YES
NO

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:

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