Subject Property
     Mortgage Information
Loan Purpose
Property Type
 Current Property Value - Refinance Only
Loan Type
 Requested Loan Amount
Requested Closing Date
 Occupancy
Property Address
 Contact me by
City, State, Zip
 Cornerstone Rep (type name)
Applicant(s) Information
Borrower's Name (Last, First, Middle Initial)
 Co-Borrower (Last, First, Middle Initial)
Home Address
 Home Address
City, State, Zip
 City, State, Zip
Home Telephone with area code
 Home Telephone with area code
Work Telephone with area code/ext.
 Work Telephone with area code/ext.
Email
 Email
Social Security # Social Security #
Date of Birth Date of Birth
Marital status
Marital status
# Dependents # Dependents
Own/Rent
# Years 		Own/Rent
# Years
Employment Information
Borrower Documentation Type
 Co-Borrower Documentation Type
Employment: Years Months Employment: Years Months
Gross Monthly Income: Gross Monthly Income:
Self Employed: Self Employed:
Mortgage/Rental Information
Current Residence

Mortgage Company Payment/Balance
1st Mortgage
2nd Mortgage
Monthly Rental Amt:
For purchase transactions only:
Source of Closing Cost: Desired Down Payment Amt:
Source of Down Payment: Purchase Price

Have you declared bankruptcy within the past 7 years? Yes No

Have you had any property foreclosed in the last 7 years? Yes No

Do you currently have a Federal Delinquency/Lien? Yes No

Are you a U. S. citizen? Yes No

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Type a message to you Loan Originator

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