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Loan Form
Borrower
First
Last
Address
Street Address
Address Line 2
City
California
State
Postal / Zip Code
United States
Country
Years at this address
Rent or Own
Rent
Own
Phone
-
(###)
-
###
####
Email
Birth Date
/
MM
/
DD
YYYY
Social Security #
Marital Status
Yes
No
Are you a U.S. Citizen?
Yes
No
Co-Borrower
First
Last
Address
Street Address
Address Line 2
City
California
State
Postal / Zip Code
United States
Country
Years at this address
Rent or Own
Rent
Own
Phone
-
(###)
-
###
####
Email
Birth Date
/
MM
/
DD
YYYY
Social Security #
Marital Status
Yes
No
Are you a U.S. Citizen?
Yes
No
Number of Dependants
Dependant Ages (seperate with commas)
Purpose of Loan
Refinance
Purchase
Cash Out
Property Usage
Primary Residence
Investment
Loan Amount
$
.
Dollars
Cents
Price
$
.
Dollars
Cents
Number of Units
Year Built
Address
Street Address
Address Line 2
City
California
State
Postal / Zip Code
United States
Country
Base Income
$
.
Dollars
Cents
Bonuses (if applicable)
$
.
Dollars
Cents
Commission (if applicable)
$
.
Dollars
Cents
Other Income
$
.
Dollars
Cents
Checking
$
.
Dollars
Cents
Savings
$
.
Dollars
Cents
Retirement Funds
$
.
Dollars
Cents
Mutual Funds
$
.
Dollars
Cents
Other
$
.
Dollars
Cents
Information for Government Monitoring
I do not wish to furnish this information
Sex
Male
Female
Ethnicity
Hispanic or Latino
Not Hispanic or Latino
Race
American Indian or Alaska Native
Asian
African American
Native Hawaiin or Pacific Island
Caucasian
Agent
Any Agent
Phil Pitts
Shawn Belknap
Kevin Camara
Michael Colo
Debby Dunmyer
Michael Oligher
Ken Pitts
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