Financial Information Form
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1Financial Information Form
Borrower
Co-Borrower
Borrower’s Name
Co-Borrower’s Name
Social Security #
Home Phone
Work Phone
Social Security #
Home Phone
Work Phone
Property Address
EMPLOYMENT
Borrower Employer
How Long?
Co-Borrower Employer
How Long?
Position
Gross /pay period
How often paid?
Position
Gross/pay period
How often paid?
$
$
# of Dependents
Net pay / period
Commission/Bonus
# of Dependents
Net pay/period
Commission/Bonus
$
$
$
$
Other monthly income - Description
Amount
Other monthly income – Description
Amount
$
$
MONTHLY EXPENSES
HOUSING
$
MISCELLANEOUS
$
OTHER
$
Hazard Insurance
Health Insurance
Bank/Finance
Electric Gas
Medical Bills
Credit card (1)
Phone
Food
Credit card (2)
Water & Sewer
Auto (1)
Credit Card (3)
Home Maint.
Auto (2)
Personal/Life Ins.
First Mortgage
Auto Insurance
Club/Union Dues
Second Mortgage
Auto Gas
Cable TV
H.O.A.
Auto Maintenance
Religious Contr.
Other Liens
Child Care
Dry Cleaning
Other
Child Support
Clothing
Other
Alimony
Entertainment
Other
Other
School Tuition
ACCOUNT BALANCES AND ASSETS
Checking A/C
Savings A/C Balance
CD/s, Stocks,
Balance
401K, IRA, Etc.
Approx. Value of
Other Assets
Home
ACKNOWLEDGEMENT AND AGREEMENT
Certification: I/We certify that the information provided in this Financial Information Form is true and correct as of the date set forth
opposite my/our signature(s) on the form and acknowledge my/our understanding that any intentional or negligent misrepresentation(s)
of the information contained on the form may result in a civil liability and/or criminal penalties. I/We authorize the lending institution
to verify this information, including verification of employment and account balances.
Borrower’s Signature
Date
Co-Borrower’s Signature
Date
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Parent category: Business