Equitystars, Inc. - Home Loans

	Borrower	Co-borrower(if different)
Full Name:
Address:
City, State, Zip
Home Phone:
Work Phone:
Best time to Contact:
E-mail:
Employer:
Employers' Phone No:
Are you self employed ?	Yes No	Yes No
Gross Monthly Income:
Length of Employment:	Yrs: Mos:	Yrs: Mos:
Date of Birth:
Social Security Number: My credit history is:	Authorize to pull credit report? Yes No excellent good, but some lates some credit problems major credit problems don't know	Authorize to pull credit report? Yes No excellent good, but some lates some credit problems major credit problems don't know

Borrower Declarations

	Borrower	Co-Borrower
Ever declared Bankruptcy?	Yes No	Yes No
Ever had a Foreclosure?	Yes No	Yes No
Are you a U.S. citizen?	Yes No	Yes No

Loan Request

Amount Requested:
Type of loan:	Purchase Refinance 2nd Mortgage Equity Line Home Improvement Debt Consolidation
Loan Type	FHA Conventional Sub-Prime

Property Information

Street Address:
City, State, Zip Code:
Estimated Present Value:
Type of Property:	Primary Residence Vacation Home Investment Property
Purchase Amount:
Expected Purchase Date:
Expected Down Payment:
Year Property Purchased:
Type of Home:	Single Family 2-4 Family Condominium
If investment property, rental income per month

Asset Information

Bank or Broker Name

Approximate Balance

Credit Information

Mortgage Balances	Amount:	Held by:	Payment:
First:
Second:
Other:

Creditors

Amount Owed

Monthly Payment

Will you pay this off ?

$

$

Yes No

$

$

Yes No

$

$

Yes No

$

$

Yes No

$

$

Yes No

$

$

Yes No

$

$

Yes No

$

$

Yes No

Other information and comments

Equitystars, Inc.

39 Broad Street

Killingly, CT 06239

Telephone: 1-877-912-7000

Fax: 401-334-6792

www.equitystars.com

Equal Housing Lender

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