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Borrower Information
Loan Officer:
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Charlie Thorne
Deanna Thorne
Nancy Hinger
Amy Church
Kim Chenoweth
Jeff Potter
Jackie Caughron
Amy Church
Laura Wilson Agee
First Name
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Co-Borrower Information
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Co-Borrower is the spouse of the Borrower
First Name
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Middle Name
Last Name
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JR
SR
II
III
IV
V
Home Phone
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Work Phone
Cell Phone
SSN
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E-Mail
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Date of Birth
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*
Age
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Own/Rent
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Living Rent Free
Rent
Own
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US Citizen?
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Permanent Resident-Alien
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Borrower Current Address Information
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Co-Borrower Current Address Information
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Zipcode
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Current Payment
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Time at this address
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Borrower Previous address (if current is less than 2 yrs)
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NH
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NM
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OH
OK
OR
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SD
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TX
UT
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Time at this address
Co-Borrower Previous address (if current is less than 2 yrs)
Address
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MI
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MO
MT
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NJ
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NY
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ND
OH
OK
OR
PA
RI
SC
SD
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TX
UT
VT
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Previous Payment
Time at this address
Borrower Employment Information
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Address
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OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
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Zipcode
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Position
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Job Length Years
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Job Length Months
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Years in Same Field
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Monthly Income
*
CoBorrower Employment Information
Employer
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Address
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City
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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
*
Zipcode
*
Position
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Job Length Years
*
Job Length Months
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Years in Same Field
*
Monthly Income
*
If at job less than two years, complete below
Employer
Address
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State
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AK
AZ
AR
CA
CO
CT
DE
DC
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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
Zipcode
Position
Job Length From:
Job Length To:
Previous Monthly Income
If at job less than two years, complete below
Employer
Address
City
State
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AL
AK
AZ
AR
CA
CO
CT
DE
DC
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
Zipcode
Position
Job Length From:
Job Length To:
Previous Monthly Income
Checking and Savings Accounts
Financial Institution
Amount $
Stocks and Bonds
Stock/Bond
Amount $
Other Assets
Other Asset
Amount $
Refinance Questionnaire
Original Purchase Price
Purchase Date
Original Loan Amount
Property Address
City
State/Zip
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AL
AK
AZ
AR
CA
CO
CT
DE
DC
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
Current Loan Amount
Current Interest Rate
Current Term
Have a Second Lien
Yes
No
Approx. Value of Home
Approx. Taxes
Approx. Homeowners Ins.
Mortgage Insurance
Yes
No
Prepayment Pentalty
Yes
No
How long do you plan on living in this home?
Additional Information
Referred By
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Comments
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I authorize InterLinc Mortgage Services and/or assigns to obtain my/our credit report for the purpose of determining credit worthiness. The information that is obtained is strictly confidential. By submitting this electronically, this is to be deemed to be the equivalent of the original.