Borrower Information
Name:
Address:
City:		State:	AL AK AZ AR CA CZ CO CT DE DC FL GA GU HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA VI WA WV WI WY	Zip:
Home Phone:		Work Phone:
Occupation:		Years Employed:
Last Years Income:		This Years Income:
		Please Rate Your Credit:	Select Excellent Good Fair Poor No History

Co-Borrower Information
Name:
Address:
City:		State:	AL AK AZ AR CA CZ CO CT DE DC FL GA GU HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA VI WA WV WI WY	Zip:
Home Phone:		Work Phone:
Occupation:		Years Employed:
Last Years Income:		This Years Income:
		Please Rate Your Credit:	Select Excellent Good Fair Poor No History

Personal Information
Have you ever filed bankruptcy?	Select Yes No	If Yes, Month and Year of Discharge:

Are you obligated to pay alimony and/or child support?	Select Yes No	If Yes, How Much Per Month:
How much can you put toward a down payment?		Source of Down Payment:
Do you own the land already?	Select Yes No	When were you put in title?
How much did you pay for the land?
Location and size of land:
What is the lands current value?
Comments

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