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Borrower Information
Co-Borrower Information
Co-Borrower is the spouse of the Borrower
First Name
*
First Name
Last Name
Last Name
Home Phone
Home Phone
Work Phone
Work Phone
SSN
*
SSN
E-Mail
*
E-Mail
Date of Birth
-
-
(Month-Day-Year)
Date of Birth
-
-
(Month-Day-Year)
Address Line 1
Address Line 1
City
City
State
- Select One -
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip
State
- Select One -
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip
Borrower Employment Information
Co-Borrower Employment Information
Employer
Employer
Address
Address
City
City
State
- Select One -
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip
State
- Select One -
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip
Position
Position
Job Length
Years
Job Length
Years
Years in Same Field
Years in Same Field
Monthly Income
$
Monthly Income
$
If at job less than two years, complete below
If at job less than two years, complete below
Employer
Employer
Address
Address
City
City
State
- Select One -
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip
State
- Select One -
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip
Position
Position
Job Length
Years
Job Length
Years
Years in Same Field
Years in Same Field
Previous Monthly Income
$
Previous Monthly Income
$
Checking and Savings Accounts
Refinance Questionnaire
Financial Institution
Amount $
Original Purchase Price
Financial Institution
Amount $
Purchase Date
Stocks and Bonds
Original Loan Amount
Stock/Bond
Amount $
Property Address
Stock/Bond
Amount $
City
Stock/Bond
Amount $
State
- Select One -
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip
Other Assets
Current Loan Amount
Other Asset
Amount $
Current Interest Rate
Other Asset
Amount $
Current Term
years
Other Asset
Amount $
Have a Second Lien
Yes
, Amount $
No
Approx. Value of Home
$
Approx. Taxes
$
per year
Approx. Homeowners Ins.
$
per year
Mortgage Insurance
Yes
No
Prepayment Penalty
Yes
No
How long do you plan on living in this home?
years
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Referred By
(required)
I authorize Envoy Mortgage and/or assigns to obtain my/our credit report for the purpose of determining credit worthiness. The information that is obtained is strictly confidential. By submitting this electronically, this is to be deemed to be the equivalent of the original.
Best Time to contact me
Date
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-
(Month-Day-Year)
Time
:
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PM
By
Email
Home Phone
Work Phone
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