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BORROWER Name: SS#: D.O.B. Home Phone Cellular Phone Work Phone Address City, St. Zip Prior Address (if less then 2 years at present address) City, St. Zip Employer Income - please specify hourly, monthly or yearly $ Hourly Monthly Yearly Bank Accounts - monthly average of all accounts Real Estate 401K Vested Retirement $ $ $

CO-BORROWER Name: SS#: D.O.B. Home Phone Cellular Phone Work Phone Address City, St. Zip Prior Address (if less then 2 years at present address) Prior City, St. Zip Employer Income - please specify hourly, monthly or yearly $ Hourly Monthly Yearly Bank Accounts - monthly average of all accounts Real Estate 401K Vested Retirement $ $ $