TYPE OF MORTGAGE AND TERMS OF LOAN I have spoken to a Loan Officer: PLEASE SELECT Melanie Swenson Keith Swenson Kelly Anast Jared Bezzant Duane Clark Mike Coutlee Angela Ferwerda Victor Hughes Angela Johnson Dee Oldroyd Don Olsen Dustin Rutherford Jennifer Stanger Jen Vining I have not talked to a Loan Officer: Amount to Borrow: Interest Rate Desired: % Type of Mortgage: PLEASE SELECT FHA Conventional USDA / Rural Housing Service VA Home Equity Line of Credit [HELOC] 2nd Mortgage Construction AMORTIZATION TYPE AND TERM:      Fixed Rate Mortgage: PLEASE SELECT 10 years 15 years 20 years 25 years 30 years 40 years      Adjustable Rate Mortgage: PLEASE SELECT 6 months 1 year 2 year 3 year 5 year 7 years 10 years PROPERTY INFORMATION AND PURPOSE OF LOAN Fill out this information if you're REFINANCING YOUR CURRENT HOME: Property Address: City: State: Zip: Value of Current Home: Year Purchased: Original Cost: Amount of Existing Loan: Purpose of Refinance: Please Select Cash Out Debt Consolidation Home Improvement Other Property will be: Please Select Primary Residence Secondary Residence Investment Property   Fill out this information if you're PURCHASING A NEW HOME: Property Address if known: City: State: Zip: Sale Price of New Home: Amount of Down Payment: Property will be: Please Select Primary Residence Secondary Residence Investment Property Do you currently have a home under contract?: Please Select Yes No When would you like to purchase?: Please Select 30 days 60 days 90 days Other Are you currently working with a realtor?: Please Select Yes No BORROWERS INFORMATION CO-BORROWER INFORMATION Name: Home Phone: (please include area code) Cell Phone: (please include area code) Work Phone: (please include area code) Married (Includes registered domestic partners) Unmarried (Includes single, divorced, widowed) Separated Present Address: City: State: Zip: Country: Do you:   PLEASE SELECT Own Rent No. of Years: If residing at present address for less than two years, complete the following (Need 2 year living history): Former Address: City: State: Zip: Did you:   PLEASE SELECT Own Rent No. of Years: *** Former Address: City: State: Zip: Did you:   PLEASE SELECT Own Rent No. of Years: Name: Home Phone: (please include area code) Cell Phone: (please include area code) Work Phone: (please include area code) Married (Includes registered domestic partners) Unmarried (Includes single, divorced, widowed) Separated Present Address: City: State: Zip: Country: Do you:   PLEASE SELECT Own Rent No. of Years: If residing at present address for less than two years, complete the following (Need 2 year living history): Former Address: City: State: Zip: Did you:   PLEASE SELECT Own Rent No. of Years: *** Former Address: City: State: Zip: Did you:   PLEASE SELECT Own Rent No. of Years: EMPLOYMENT INFORMATION BORROWERS INFORMATION CO-BORROWER INFORMATION Name of Employer Address of Employer City: State: Zip: Yrs. on this job: Position/Title: Business Phone (please include area code) Self-Employed: PLEASE SELECT Yes No If employed in current position for less than two years or if currently employed in more than one position, complete the following (Need 2 year employment history): Name of Employer Address of Employer City: State: Zip: Employment Dates: mm/yy to mm/yy Monthly Income: Position/Title: Business Phone (please include area code) Self-Employed: PLEASE SELECT Yes No  *** Name of Employer Address of Employer City: State: Zip: Employment Dates: mm/yy to mm/yy Monthly Income: Position/Title: Business Phone (please include area code) Are you self employed: SELECT Yes No Name of Employer Address of Employer City: State: Zip: Yrs. on this job: Position/Title: Business Phone (please include area code) Self-Employed: PLEASE SELECT Yes No If employed in current position for less than two years or if currently employed in more than one position, complete the following (Need 2 year employment history):  Name of Employer Address of Employer City: State: Zip: Employment Dates: mm/yy to mm/yy Monthly Income: Position/Title: Business Phone (please include area code) Self-Employed: PLEASE SELECT Yes No  *** Name of Employer Address of Employer City: State: Zip: Employment Dates: mm/yy to mm/yy Monthly Income: Position/Title: Business Phone (please include area code) Are you self employed: SELECT Yes No MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION Gross Monthly Income (Total of all gross pay including bonuses, overtime, shift premium, commissions, distributions, dividends, interest and rental income.) BORROWERS INFORMATION CO-BORROWER INFORMATION Gross Monthly Income: Gross Monthly Income: MONTHLY HOUSING EXPENSE BORROWERS INFORMATION CO-BORROWER INFORMATION Payment or Rent: Payment or Rent: OTHER INCOME: Alimony, child support, or separate maintenance income need not be revealed if the Borrower or Co-Borrower does not choose to have it considered for repaying this loan. BORROWERS INFORMATION CO-BORROWER INFORMATION Have you been divorced?: Select Yes No Have you been divorced?: Select Yes No Do you pay alimony?  Select Yes No Do you pay alimony?  Select Yes No If Yes, amount paid monthly: If Yes, amount paid monthly: Do you pay child support? Select Yes No Do you pay child support? Select Yes No If Yes, amount paid monthly: If Yes, amount paid monthly: Do you receive alimony? Select Yes No Do you receive alimony? Select Yes No If Yes, amount recieved monthly: If Yes, amount recieved monthly: Receive child support? Select Yes No Receive child support? Select Yes No If Yes, amount recieved monthly: If Yes, amount recieved monthly: ASSETS AND LIABILITIES Checking and Savings Account Information BORROWERS INFORMATION CO-BORROWER INFORMATION Name of Bank, S&L or Credit Union Address City: State: Zip: Amount in Account: Name of Bank, S&L or Credit Union Address City: State: Zip: Amount in Account: Name of Bank, S&L or Credit Union Address City: State: Zip: Amount in Account: Name of Bank, S&L or Credit Union Address City: State: Zip: Amount in Account: Name of Bank, S&L or Credit Union Address City: State: Zip: Amount in Account: Name of Bank, S&L or Credit Union Address City: State: Zip: Amount in Account: Name of Bank, S&L, or Credit Union Address City: State: Zip: Amount in Account: Name of Bank, S&L, or Credit Union Address City: State: Zip: Amount in Account: Stocks and Bonds BORROWERS INFORMATION CO-BORROWER INFORMATION Amount: Amount: Retirement Accounts (IRA, 401K, etc.) BORROWERS INFORMATION CO-BORROWER INFORMATION Amount: Amount: Life insurance net cast value BORROWERS INFORMATION CO-BORROWER INFORMATION Face Amount: Face Amount: Real Estate Owned BORROWERS INFORMATION CO-BORROWER INFORMATION Market Value: Market Value: Net Worth of Business(es) owned BORROWERS INFORMATION CO-BORROWER INFORMATION Amount: Amount: Automobiles/Boats/Trailers/Motorcycles/etc. BORROWERS INFORMATION CO-BORROWER INFORMATION Year: Make: Model: Year: Make: Model: Year: Make: Model: Year: Make: Model: Year: Make: Model: Year: Make: Model: Year: Make: Model: Year: Make: Model: CREDIT OPINION BORROWERS INFORMATION CO-BORROWER INFORMATION My credit is: Select Excellent Good Average Poor My credit is: Select Excellent Good Average Poor DECLARATIONS   BORROWER CO-BORROWER YES NO YES NO Are there any outstanding judgements against you? Have you declared bankruptcy within the past 7 years Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years Are you a party to a lawsuit? Have you directly or indirectly been obligated on any loan which resulted in foreclosure or judgment? Are you presently delinquent or in default on and Federal debt or any other loan, mortgage, financial obligation, bond or loan guarantee? Are you obligated to pay alimony, child support, or separate maintenance? Is any part of the down payment borrowed? Are you a co-maker or endorser on a note? Are you a U.S. citizen? Are you a permanent resident alien? Do you intend to occupy the property as your primary residence? Have you had ownership interest in a property in the last three years? What type of property did you own? [PR = Principal Residence, SH = Second Home, IP = Investment Property] Select PR SH IP Select PR SH IP How did you hold title to the home – [Solely by yourself (S), Jointly with your Spouse (SP), or jointly with another person (O)? Select S SP O Select S SP O BORROWER: I hereby authorize Alliance Capital Funding, Inc. to access my credit report for the purpose of pre-qualifying me for a mortgage loan. Yes   No CO-BORROWER: I hereby authorize Alliance Capital Funding, Inc. to access my credit report for the purpose of pre-qualifying me for a mortgage loan. Yes   No Comments

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