BORROWER’S INFORMATION
Name (add Jr./Sr. if needed) :
 I authorize Rodney Anderson with
Supreme Lending to obtain my credit report
Social Security Number : (9 digits)
Birth Date :
Street Address :
City : State: Zip:
Cell Phone Number :()  - 
Work Phone Number :()  - 
Employer :
Position :
Years at Job :
CO-BORROWER’S INFORMATION (IF APPLICABLE)
Name (add Jr./Sr. if needed) :
 I authorize Rodney Anderson with
Supreme Lending to obtain my credit report
Social Security Number : (9 digits)
Birth Date :
Street Address :
City : State: Zip:
Cell Phone Number :()  - 
Work Phone Number :()  - 
Employer :
Position :
Years at Job :
PROPERTY INFORMATION
Loan Type :PurchaseRefinance
Have you found a home?YesNo
Price Range:
Type of home:
When are you planning to move?
How much are you putting down?
Realtor:
Current resident type :
Time at Residence :
If rent, amount you pay?
If own are you selling?YesNo
What do you estimate equity to be?
When did you purchase your house? / (year)
What type of Loan are you on?
Have you ever taken CASH OUT?YesNo
Monthly Payment :
Current Interest Rate :
Term :
Balance :
Current Home Value :
Last Year's Property Taxes :
Do you escrow?YesNo
Current Escrow Balance:
Annual Homeowners Insurance Premium :
Date of Renewal for Homeowners Insurance : / (year)
Property Type :
Refinance Goals :
ADDITIONAL INFORMATION
Marital Status :
Child Support :
(if applicable to you or spouse) 
Pay $ per month
Receive $ per month
Email Address :
Add me to your emailing list.
How Did You Hear About Us :
Comments :