Zale Financial

General Information

Borrower:

Co-Borrower:

Address:

Address:

Telephone:

Telephone:

Email:

Email:

Best time to Phone:

Best time to Phone:

Social Security #:

Social Security #:

Employment Information

Borrower:

Co-Borrower:

Employer:

Employer:

Job Title:

Job Title:

Annual Income:

Annual Income:

Telephone:

Telephone:

Property Information

Current Value:

Current Loan:

Loan Wanted:

Current Rate:

Property To Be Pledged:

Loan Request

for:    Purchase: Refinance: Cash Out Refinance: Other:

use:   Primary Home: Second Home: Rental: Commercial:

Type of Property

House: Townhome/Condo: Mobil Home: Commercial: Land:

Credit History

Borrower:

Co-Borrower:

Excellent:

Excellent:

Good - few lates:

Good - few lates:

Some Credit Problems:

Some Credit Problems:

Major Credit Problems:

Major Credit Problems:

Declarations

Borrower:

Co-Borrower:

Yes: No:

Are there any outstanding Judgments against you?

Yes: No:

Yes: No:

Have you filed Bankruptcy in the past 10 years?

Yes: No: