SSN:  ___________________  DOB:  __________________________

Co-Borrower's Name (First,MI,Last): ____________________________________________

 

SSN:  ___________________  DOB:  __________________________

 

Present Address:__________________________________________

 

Prev. Address (if less than 2 yrs):______________________________

 

Borrower/Employment:_____________________________________

 

Borrower/Prev Emp(if less than 2 yrs):__________________________

 

Current wages:  $____________2003 Wages (W2/1099): $_________

 

Co-Borrower/Employment:___________________________________

 

Co-Borrower/Prev Emp(if less than 2 yrs):_______________________

 

Current wages:  $____________ 2003 Wages (W2/1099): $_________

 

Present rent or mortgage payment:$___________ per month

 

Checking Acct? Yes___No___Savings Acct?  Yes ___ No___

 

Permission to review credit report:  Bor: Yes__No__  Co-Bor: Yes__No__

 

Borrower:________________________________Date:___________

                Signature

 

Co-Borrower:_____________________________Date:___________

                      Signature