FAST APPLICATION- BORROWER INFORMATION

Date:___/___/_____ Amount requested:_____________ Purpose_________________

Name:___________________________ Age:_________ Social sec.#____/___/______

Co. Applicant:_____________________ Age:_________ Social sec.#____/___/______

St' Address:______________________________ City __________ Zip ____________

HOUSE INFORMATION

Date purchased___/___/____Amt. Paid $_____________ Current value:$__________

1st Mortgage holder _____________________________ Balance $_______________

Payment Amt._______________ Loan #:_____________________________________

2nd Mortgage holder_____________________________ Balance $_______________

Payment Amt._______________ Loan #:_____________________________________

EMPLOYMENT INFORMATION

Employer:__________________________________ Years on the job:_____________

Yearly Gross Salary:$__________________

Co.App Employer:____________________________Years on the job:_____________

Yearly Gross Salary:$__________________

Source of other Income:___________________ Amount of other income: $_________

TOTAL INCOME:$_________________

Home phone:_____/_____/________ Work phone:_____/_____/________

Co App # :_____/_____/__________ Cell phone:_____/_____/_________

I Hereby Certify that All statements In This Application Are True And Complete And Are Made For The Purpose Of Obtaining Credit. I Authorize You To Obtain Such Information As You May Require Concerning The Statements Herein And Agree The Applicant Shall Remain Your Property.

Signature:____________________ Co.App Signature____________________________