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Information
Borrower
Co-Borrower
First Name
Middle Initial
Last Name
Social Security Number
Birthdate (mm/dd/yr)
Home Phone (including Area Code)
Marital Status

Number of Dependents
Present Street Address
City
State
Zip
How Long at Current Address? (mm/dd/yr)
Prior Address (if less than 2 years)
City
State
Zip
How Long at Prior Address? (mm/dd/yr)
Employer Name
Job Title
Hire Date (mm/dd/yr)
Work Phone (including area code)
Gross Monthly Salary
Bonus/Overtime amount
Work Address
City
State
Zip
Former Employer Name
(if less than 2 years)
Former Position
Work Phone (including area code)
Gross Monthly Salary
Bonus/Overtime amount
Dates Employed (mm/dd/yr)
Work Address
City
State
Zip
Other Income? (Including dollar amount and source)
Information About Your Home
Purchase Date (mm/dd/yr) Purchase Price Down Payment
Value Today Date of Last Refi (mm/dd/yr) ARM or Fixed
1st Trust Deed Lender Balance Payment
2nd Trust Deed Lender Balance Payment
Total Loan amount requested  
       
Information About Your Pool Project
Builder/Contractor
Salesman
Total Pool Loan amount
Bankruptcy Information
Have you filed for bankruptcy in the last 10 years
Discharge Date (mm/dd/yr)
Information requested by Federal Government
(if you do not wish to provide, please check the decline box)

 

Borrower:
I decline to furnish this information

White Black or African American Hispanic or Latino
American Indian or Alaskan Native
Asian or Pacific Islander

Male Female

Co-Borrower:
I decline to furnish this information

White Black or African American Hispanic or Latino
American Indian or Alaskan Native
Asian or Pacific Islander

Male Female

We authorize you or anyone you may designate to verify any of this information
directly or through a credit agency. This information is true and correct.

Borrower -- YES Co-Borrower -- YES

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