Borrower Information:

Name:

Street:

City, State, Zip:

Rent:

Own:

Other:

No. of Years:

Landlords Name:

Landlords Phone:

(If less than 2 years)

Street:

City, State, Zip:

Rent:

Own:

Other:

No. of Years:

From (Date):

To (Date):

Married:

Unmarried:

Separated:

Social Security No:

Date of Birth:

Home Phone:

Cell Phone:

**EMail:

Borrower Employment Information:

Employer:

Name of person to verify employment:

Street:

City, State, Zip:

Title:

Monthly Income:

(If less than 2 years)

Employer:

Street:

City, State, Zip:

Title:

From (Date):

To (Date):

Phone Number:

Monthly Income:

Years in Profession:

I/we authorize Countrywide Home Loans to verify my/our credit information.

** Required Field

Co-Borrower Information:

Name:

Street:

City, State, Zip:

Rent:

Own:

Other:

No. of Years:

Landlords Name:

Landlords Phone:

(If less than 2 years)

Street:

City, State, Zip:

Rent:

Own:

Other:

No. of Years:

From (Date):

To (Date):

Married:

Unmarried:

Separated:

Social Security #:

Date of Birth:

Home Phone:

Cell Phone:

EMail:

Co-Borrower Employment Information:

Employer:

Name of person to verify employment:

Street:

City, State, Zip:

Title:

Monthly Income:

(If less than 2 years)

Employer:

Street:

City, State, Zip:

Title:

From (Date):

To (Date):

Phone Number:

Monthly Income:

Years in Profession: