Buyer/Borrower #1 Name: Home Phone: Work Phone: Cell Phone: Fax Number: Single Married Seperated Buyers Birthdate: Social Security Number: Number of Children: Age of Children: Current Address Rent Own Years Street: City: State: Zip: Previous Address (If less than 2 years at present address) Street: City: State: Zip: Employment Information Self Employed: Yes No Years at current job: Years in line of work: Employer/Position: Street: City: State: Zip: Monthly Income (Gross): Bank Balance: Value of Home: Buyer/Borrower #2 Name: Home Phone: Work Phone: Cell Phone: Fax Number: Single Married Seperated Buyers Birthdate: Social Security Number: Number of Children: Age of Children: Current Address Rent Own Years Street: City: State: Zip: Previous Address (If less than 2 years at present address) Street: City: State: Zip: Employment Information Self Employed: Yes No Years at current job: Years in line of work: Employer/Position: Street: City: State: Zip: Monthly Income (Gross): Bank Balance: Value of Home: I/We hereby authorize Mortgage Financing Services, its agents or assigns to verify and/or confirm information contained herein for the purposes of determining my/our creditworthiness and credit limits for a mortgage. Further, by this instrument or a facsimile thereof, I/we authorize any individual or organization to provide such verification and/or confirmation. This does not constitute a commitment to loan money. Mortgage credit must be obtained by formal application.   Please check this box if you have read and agree with the above statement. Property Information (If Available) 1st Mortgage: Rate on 1st: 2nd Mortgage: Rate on 2nd: Manufactured/ Module: Yes No If purchase Down Payment: