Lender Information
Company Name
Ordered By
Person Responsible For Payment
Phone #
Fax #
E-mail
Fill this next part out if it differs from above
Lender Name (On Report)
Address
City
State
ZIP
Applicant Information
Applicant(s) Name(s)
Address
City
State
ZIP
Home Phone#
His Work Phone#
Her Work Phone#
Sale
Amount of Sale
(Need Offer to Purchase if it's a Sale)
Broker's Name
Phone #
Refinance
Est. Value of Refinance
Property Type
Other / Don't Know
Single Family
Two Family
Three Family
Four Family
Condo
PUD
Land
Type of Loan
Other / Don't Know
Fannie Mae
Freddie Mac
FHA
VA
In House
FHA #
(For FHA Loans Only)
Enter Other Notes Here: