Barthanselman.americanmortgage.com



Completed for Bart HanselmanEmail: Bart.Hanselman@ Phone: 937 657-9797 Fax: 888-410-0469 Realtor: Email: Phone Number FORMTEXT ????? FORMTEXT ?????Buyer (Provide Complete Legal Name) DOB Social Security Number FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Co-Buyer (Provide Complete Legal Name) DOB Social Security Number FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Home Phone Number Work Phone Number Cell Phone Number E-Mail Address FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Current Address # of yrs./mo. City State Zip Code FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Previous Address # of yrs./mo. City State Zip Code( If less than 2 yrs please fill in previous address above) FORMCHECKBOX Rent Rent Pymt $ FORMTEXT ?????Apartment Complex Name FORMTEXT ????? FORMCHECKBOX Own Mtg Pymt $ FORMTEXT ?????Estimated Home Value FORMTEXT ?????Are buyers married? FORMCHECKBOX Yes FORMCHECKBOX NoDependents: FORMTEXT ?????Ages: FORMTEXT ?????Does Either Borrower Pay Child Support/Alimony? FORMCHECKBOX Yes FORMCHECKBOX No per Month $ FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Buyer’s Employer Job Title Work # Time There (yr./mo.)Income FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Buyer’s Employer (Previous) Job Title Work # Time There (yr./mo.)Income FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Co-Buyer’s Employer Job Title Work # Time There (yr./mo.)Income FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Co-Buyer’s Employer (Previous) Job Title Work # Time There (yr./mo.)IncomeASSETS:Checking/Savings: $ FORMTEXT ?????Sale of Home: $ FORMTEXT ?????Gift: FORMTEXT ?????401K/Retirement: $ FORMTEXT ?????Other: $ FORMTEXT ?????DEBTS (Use required minimum monthly payments when disclosing debt. )Total Monthly Debts: $ FORMTEXT ?????Total monthly debt to be paid off prior to close: $ FORMTEXT ?????Debt Breakdown:Car Pymt $ FORMTEXT ?????Car Pymt $ FORMTEXT ?????Cred. Card $ FORMTEXT ?????Cred. Card $ FORMTEXT ?????Credit Card $ FORMTEXT ?????Student loan $ FORMTEXT ?????Other FORMTEXT ?????Other $ FORMTEXT ?????Other FORMTEXT ?????(If student loan is deferred, how long?)I/We Authorize American Mortgage Service Company to order a consumer credit report. The information obtained by American Mortgage Service Company is only to be used to pre-qualify buyers for financing and should not be considered as a commitment or approval of such financing.Borrower’s Signature:Co-Borrower’s Signature: ................
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