To apply for a loan, please fill out all the following information completely and accurately. We will send the results back to you via email. This application is secure. If you do not wish to send this form electronically, please print it out and fax it to us at (847) 368 - 1210.
Items in bold are required.

Borrower Information
	Borrower	Co-Borrower
First Name
Last Name
Date Of Birth
Social Security #
Street Address
City
State
Zip
Home Phone #
Work #
E-Mail
FAX Number

Property Information
Property Street Address	City, State, Zip
Purchase Price	Date of Purchase
Current value of the house	Monthly Payment
Mortgage Balance	Interest Rate
Type of Home Permanent Residence Manufactured Home: Doublewide NOT in a Park Manufactured Home: Singlewide NOT in a Park Manufactured Home: Doublewide in a Park Manufactured Home: Singlewide in a Park Mobile Home: Doublewide NOT in a Park Mobile Home: Single wide NOT in a Park Mobile Home: Doublewide in a Park Mobile Home: Singlewide in a Park

Employment Information
	Borrower	Co-Borrower
Employer
Position
# of Years
Gross Salary	Per Hour Week Month Year	Per Hour Week Month Year

Assets
	Borrower	Co-Borrower
Savings, Money Mkt., Stock	$	$
Retirement, 401-K	$	$
Gift Funds Available	$	$
Bank Name
Bank Account #
Bank Balance	$	$

Liabilities
	1st Mortgage	2nd Mortgage
Lender
Balance $
Date Opened
Payment $
Current Rate	%	%
Rate Type	Fixed Adjustable	Fixed Adjustable
	Car #1	Car #2
Lender
Value $
Balance $
Payment $
Year/Make
	Credit/Loan #1	Credit/Loan #2
Type	Credit Card Personal Loan	Credit Card Personal Loan
Name
Balance $
If loan, Payment $
	Credit/Loan #3	Credit/Loan #4
Type	Credit Card Personal Loan	Credit Card Personal Loan
Name
Balance $
If loan, Payment $

Loan Details
I would like to: Purchase  Purchase Price   Refinance  Est. Home Value
Loan Amount Requested:	$
Maximum Mortgage Payment Desired:	$
The Loan Program I'm Interested in is:	Best Program for me 30 Year Fixed  15 Year Fixed  Adjustable (ARM)  I Don't Know Yet
What is the purpose of this loan?
Have you found a house yet? Not applicable No Yes, but want to know if we qualify Yes, but we haven't made an offer yet! Yes, and we have a purchase and sale agreement
Have you had foreclosure in the last 10 years?	-Select- No Yes
If yes, when
Are you obligated to pay alimony, child support, separate maintenance?	-Select- No Yes
If yes, Amount Per Month $
Bankruptcy in the last 10 years?	-Select- No Yes
If yes, when

Comments or any other information we may need to know:

Please enter the name of the Customer service representative you spoke with, if applicable:

Please inform me via email of your future products/offerings

For highest priority & quickest approval, please FAX employer W-2 forms for the past 2 years along with any recent paystub.