Borrower Financial Form

Borrower Financial Form

Loan # ________________

Property Address :

____________________________________________________________________________________

Borrower Information

Borrower's Name

Co-Borrower's Name

Social Security #

Home Phone #

Work Phone #

Social Security #

Home Phone #

Work Phone #

Mailing Address

Mailing Address

Do you occupy the property? Yes_____ No_____

If Rental: Monthly Rental income $______

If No: Is the property a Rental property? Yes_____ No_____

Last date owner occupied __________

Have you filed Bankruptcy? Yes_____ No_____

If Yes: Chapter 7 _____ Chapter 13_____

Filing Date:______

Any other liens on subject property? Yes_____ No_____

If Yes: Is it Current? Yes_____ No_____

Balance Due $______________

Monthly Income

Borrower-Employer

Position

Years

Co-Borrower-Employer

Position

Years

Gross Wages:

$

Gross Wages:

$

Net Wages:

$

Net Wages:

$

*Alimony, child support or separate maintenance income need not be revealed if the Borrower / Co-Borrower does not choose to have it considered for approval of a loan workout.

Child Support:

$

Child Support:

$

Alimony:

$

Alimony:

$

Rental Income:

$

Rental Income:

$

**Other Income: (Please itemize separately and enclose with this document)

Monthly Expenses

Assets (Estimated Values)

Food

$

Auto Loans

$

/ $

Home

$

Utilities

$

Personal Loans

$

/ $

Other Real Estate

$

Transportation

$

Student Loans

$

Checking Accounts

$

Auto Insurance

$

Tuition

$

Savings/Money Market

$

Life Insurance

$

Other Mortgages/Rent

$

/ $

IRA/Keogh Accounts

$

Child Support

$

401K/ESOP Accounts

$

Alimony

$

Stocks, Bonds, CD's

$

Child Care

$

Other Investments

$

Credit Cards

$

Other Investments

$

**Other Expense: (Please itemize separately and enclose with this document)

I Agree that the financial information provided is an accurate statement of my financial status. I understand and acknowledge that any action taken by the

lender of my mortgage loan on my behalf will be made in strict reliance on the financial information provided. My signature below grants the lender the

authority to confirm the information I have disclosed in this financial statement, to verify that it is accurate by ordering a credit report and to contact my

real-estate agent and / or credit counseling service representative if applicable. Discussions and negotiations of a possible foreclosure alternative

will not constitute a waiver of or defense to my lender's right to commence or continue any foreclosure or other collection action and an alternative to

foreclosure will be provided only if an agreement has been approved in writing by my lender. I may be required to provide additional information.

I acknowledge the following:

A property appraisal and a broker's price opinion may be required as part of the review process. I may be responsible for the costs incurred for the same.

Whether or not the workout is approved or denied, I may be responsible for the costs incurred (if applicable) and they may be added to the amount

due and secured by my mortgage. If an appraisal or broker's price opinion is ordered, access will be required to the property by the appraiser and/or broker.

Signature of Borrower

Date

Signature of Co-Borrower

Date

Last Revised

09/09/2009