Your Full Name
Street Address
City		State Zip
Phone Number
Email Address
Purchase Price (if you are buying this home)	$
Estimated Value of Your Home If You Are Refinancing	$
Loan Amount (the amount you wish to borrow)	$
Will this loan be placed on your:		Primary Residence
		Vacation Home
		Rental Property
Your current monthly salary from all sources	$
Your monthly commissions or bonuses averaged for the last two years, if any.	$
Your total liquid assets i.e. checking, savings, stocks, bonds, IRA's, CD's, money market accounts, 401K plans, etc. that have been under your control for at least the last 90 days.	$