PERSONAL DATA:

Borrower Name:	(inc. middle initial)
Co-Borrower:	(inc. middle initial)
Current Address:
City:
State:	AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Zip:
How Long:	Own    Rent
	If less than 2 years at current residence, please provide 2 year history with all information on previous residences, along with dates:
Borrower SS#:
Co-Borrower SS#:
Borrower DOB:
Co-Borrower DOB:
# Dependants:	Age(s):
Borrower Wk. Phone:
Co-Borrower Wk. Phone:
Home Phone:

EMPLOYMENT HISTORY:

Borrower Present Employer:
Address:
Position:
How Long:
Gross Income:	$ per week month year
Co-Borrower Employer:
Address:
Position:
How Long:
Gross Income:	$ per week month year
	If less than 2 years on current employment, please provide 2 year history on previous employers including dates of employment, etc., with complete address(es) and phone number(s):

ASSETS:
(include checking, savings, money market accounts, etc., on accounts that will be used for down payment)

Bank:
Average Balance:	$
Bank:
Average Balance:	$
Bank:
Average Balance:	$

MORTGAGE INFORMATION:
(If applicable)

Current Mortgage Holder:
Phone #:
Address:
Balance (if applicable):	$
Est. Value of Your Home:	$
Purpose of Loan:	Purchase     Refinance
Loan Term:	15 year   20 year   30 year
Loan Type:	Conventional  FHA

I/We have made a pre-approval request for maximum loan amount information. I/We understand that I/we have not identified any specific property to the lender, nor have I/we made a written application for a loan with the lender. Any information provided by the lender regarding loan amount is subject to the property I/we select appraising in excess of the minimum value required for the loan program I/we select. Such information is also subject to verification of all data I/we will be required to provide on a written application. I/We the consumer, direct Wells Fargo Home Mortgage, Inc. to obtain a copy of my credit report. The consent shall automatically expire thirty (30) days from the date typed above.

Realtor:

Home Mortgage Consultant:
Glen Smithen
Wells Fargo Home Mortgage
2020 N. Tyler #102
Wichita, KS 67212
Office: 316-721-9271, ext. 118
Fax: 316-721-8691

Wells Fargo Home Mortgage, Inc. is licensed by the Department of Corporations under the California Residential Mortgage Lending Act, originates mortgage loans in New Hampshire under License No. 5757 MB for first mortgages and License No. 5768 MHL for second mortgages and is a New Jersey Department of Banking Licensed Mortgage Banker. © 2002 Wells Fargo Home Mortgage, Inc. All Rights Reserved.

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