Full Name: Street Address: City: State: Zip: Phone Number: Email Address: Purchase Price (if you are buying this home): Estimated Value of Your Home If You Are Refinancing: Loan Amount (the amount you wish to borrow): Will this loan be placed on your: Primary Residence: Vacation Home: Rental Property: Your current monthly salary from all sources: $ Your monthly commissions or bonuses averaged for the last two years, if any. $ Your total liquid assets i.e. checking, savings, stocks, bonds, IRA's, CD's, money market accounts, 401K plans, etc. that have been under your control for at least the last 90 days. $