Where did you hear about us? Which Loan officer are you working with?

Borrower

First Name Last Name Middle Name Date Of Birth

Email Phone Number

Address

City State Zip Code

Own Years Months

Rent $ Monthly Rent Years Rented Months Rented

If Less Than 2 Years

Address

City State Zip Code

How Long Years Months

Employment

Employment Employer

Occupation/Title Start Date Years in Field

Hourly pay $ Average Hours Worked in a Week

If Less than 2 Years

Employment Employer

Occupation/Title Start Date Years in Field

Hourly pay $ Average Hours Worked in a Week

Co-Borrower

First Name Last Name Middle Name Date Of Birth

Address

City State Zip Code

Own Years Months

Rent $ Years Months

If Less Than 2 Years

Address

City State Zip Code

How Long Years Months

Employment

Work Status Employer

Occupation/Title Start Date Years in Field

Hourly pay $ Average Hours Worked in a Week

If Less than 2 Years

Work Status Employer

Occupation/Title Start Date End Date

Hourly pay $ Average Hours Worked in a Week

Preferred Contact Preferred Time

Children? # Of Children Ages

Child Support Dollars($)

Almony Dollars($)

Other Properties

Address

City State Zip Code

How Long Years Months

Credit Information

Bankruptcy in last 7 years CH. 13 CH. 7

Discharge Date

Late Payments over 30 days in last 24 months? # of Days

Outstanding Judgments Dollars($)

Property Foreclosures Delinquent on Federal Debt? Dollars($)

Rate your Credit 1 to 10 (1 being worse) Other Credit Issues

Purpose Of Loan

Are You Working with A Realtor If Yes Realtor Name Phone

Has your Home been listed for sale in the last 90 days? If Yes date take off market

Desired Mortgage Payment? Purchase Price?

Assets

Checking Balance $ Savings Balance? $

Stocks/bonds/410k $ Estimated Value $

This is to certify that I have provided the information given above for preliminary mortgage qualifying purposes and that it is true and correct to my knowledge. By signing this application, I certify and authorize Main St Mortgage Inc to obtain credit-reporting information in order to make a preliminary credit decision. This application in no way implies credit approval nor the a promise from Main St. Mortgage Inc to provide a loan. The approval is pending verification of all financial information, income information and completion of the actual mortgage application process. I also give Main St Mortgage Inc. permission to contact me electronically via e-mail or text.

Application