Borrower Assistance Form Page 3
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1
2
3
4Borrower Name:
Loan number:
MONTHLY INCOME INFORMATION
Borrower
Co-Borrower
Income Source
Income Source
Monthly Net
(Employer Name,
(Employer Name,
Monthly Net Income
Rental,
Rental,
Income
Employer:
$
Employer:
$
Employer:
$
Employer:
$
Employer:
$
Employer:
$
Employer:
$
Employer:
$
Rental Income:
$
Rental Income:
$
Other:
$
Other:
$
Other:
$
Other:
$
Total
Total
$
-
$
-
Additional Income Description
Borrower / Co
Alimony, child support, or separate maintenance income need not be revealed if Borrower or
Monthly Amount
Borrower
Co-Borrower does not choose to have it considered for approval of a loan workout.
$
$
$
Total
$
-
ASSETS
Amount
Amount
ASSETS
Value
Vehicle
Model/Year
Value
Owed
Owed
Home
$
$
Automobile
$
$
Other Real Estate
$
$
Automobile
$
$
Retirements Funds
$
$
Automobile
$
$
Investments
$
$
Motorcycle
$
$
Checking Balance
$
$
Boat
$
$
Savings Balance
$
$
Motor Home
$
$
Other:
$
$
Airplane
$
$
Other:
$
$
Other:
$
$
Other:
$
$
Other:
$
$
Total
$
-
$
-
Totals
$
-
$
-
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