Form Gary Kurzynski

Where Do You Want To Live

Type of home you're purchasing:

Street name

City

State

Zip

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How much you want to spend?

What's the purchase price of the house?

How much down payment do you have available?

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Where You Live Now

Primary Address:

Street name

City

State

Zip

Do you:

How long have you lived here? *A two-year residence history is required

Years

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Tell Us About Yourself

First Name * This field is required.

MI

Last Name * This field is required.

Primary Address:

Street Name

City

State

Zip

Date of Birth:

Phone: * e.g. (800) 867-5309

Your Email Address *

Years of Education Completed:

Years

Marital Status:

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Your Employment

Are you currently employed?

Employer's Name

Your title

Employer's Phone Number
Phone: e.g. (800) 867-5309

Employer's Address:

Street Name

City

State

Zip

How long have you been in this line of work?

Years

Have you been at this job more than 2 years? Please enter the date you started:

Bussiness Name

Your title

Business Phone Number
Phone: e.g. (800) 867-5309

Business Address:

Street Name

City

State

Zip

Have you been at this job more than 2 years? Please enter the date you started:

*Self-employed borrower(s) may be required to provide additional documentation such as tax returns and financial statements.

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Your Income

Do you have any:

My total overtime monthly income is:

My total dividends/interest monthly income is:

My total bonus monthly income is:

My total monthly rental income is:

My total commission monthly income is:

My total monthly child support income is:

My total monthly income for this source is:

As additional income, you can add separate maintenance, disability and more...

Notice: Alimony, child support, or separate maintenance income do not need to be revealed if the borrower or co-borrower does not choose to have it considered for repaying this loan.

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Where Do You Want To Live

How much you want to spend?

Where You Live Now

Primary Address:

Do you:

Tell Us About Yourself

Primary Address:

Your Employment

Employer's Address:

Business Address:

Your Income

Do you have any:

Your Assets

Please enter your assets below by selecting account type:

Questions

Please answer a few questions: