Purchaser Information

Online Mortgage Application

Purchaser Information:

Purchaser (Full Name):
Age:
Social Insurance #:
Residence Phone #:
Business Phone #:
Present Address:
Years at Present Address:		Own $ or
		Rent $/month

Previous Address:

Marital Status:	Married Separated Unmarried (including single, divorced, or widowed)

Occupation: (Position & Title)
# of years:
Place of Employment: (Name & Address)
Previous Employer: (Name & Address)

Co-Purchaser Information:

Co-Purchaser (Full Name):
Age:
Social Insurance #:
Residence Phone #:
Business Phone #:
Present Address:
Years at Present Address:		Own $ or
		Rent $/month

Previous Address:

Marital Status:	Married Separated Unmarried (including single, divorced, or widowed)

Occupation: (Position & Title)
# of years:
Place of Employment: (Name & Address)
Previous Employer: (Name & Address)

Gross Annual Income:

	Purchaser	Co-Purchaser
Self-Employed ?	Yes No	Yes No
Base Salary:	$	$
Overtime:	$	$
Bonuses:	$	$
Commissions:	$	$
Dividends:	$	$
Net Rental Income:	$	$
Other:	$	$
Total:	$	$

Do You Intend To Occupy This Property ? Yes No
Number of Children:
Ages:
Other Dependents:

Assets:

Checking:	$	Bank:
	$	Bank:
Savings:	$	Bank:
	$	Bank:
Credit Union:	$	Bank:
Stocks:	$
Bonds:	$
Life Insurance:	$

Present Residence (If Owned):
Market Value:	$
Mortgage Value:	$
Lender:

Other Assets (Specify):

Liabilities:

(List outstanding obligations including auto loans, mortgage payments, credit cards, personal loans, and all other loans.)

Type	Creditor's Name	Unpaid Balance		Due Date	Monthly Payment
		$			$
		$			$
		$			$
	Total:	$			$

Additional Monthly Obligations:
Alimony:		$
Child Support:		$
Child Care:		$


Are There Any Judgements or Lawsuits Present?			Yes No
Amount:			$

Is Any Part of the Down Payment or Settlement Costs Being Obtained From a Source Other Than From Assets Listed Above?			Yes No