Application:Full for SureCredit USA

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Full Application

APPLICANT INFORMATION

Borrower

Co-Borrower

*First Name:

*Last Name:

Social Security No.:

Marital Status:

Dependants:

No. and Ages (not listed by other borrower); (i.e.: 2; 14, 17)

Work Phone:

*Home Phone:

*eMail:

Best Time To Call:

(i.e. 8-10pm)

Age:

Yrs. School:

Status:

Years

*Street Address:

Address (cont.):

*City:

*State/Province:

*Zip/Postal Code:

*Country:

If residing at present address for less than two years, complete the following in blue text.

Former Status:

Years

Former Address:

Address (cont.):

City:

State/Province:

Zip/Postal Code:

Country:

Former Status 2:

Years

Former Address 2:

Address (cont.):

City:

State/Province:

Zip/Postal Code:

Country:

What is the Purpose of Your loan? Check all that apply.
Refinance	Debt Consolidation
Educational	Home Improvements
Investments	Vacation
Cash Needed ($0.00)

Subject Property

Street Address:

Address (cont.):

City:

State/Province:

Zip/Postal Code:

Country:

Property Type:

Purchase Price:

Date Purchased:

Estimated Value:

Year Built:

Occupancy:

Have improvements been made to the house since purchase?

If Yes, "What improvements?" and "What was the cost?"

Current Mortgage Information
Mortgage	Balance	Payment	Interest Rate	Date Opened	# of Payments Past Due
1st
2nd
3rd

Credit
How many times, in the past 12 months have you been late on your:
Mortgage payment?
more than:	30 days	60 days	90 days	120 days

Credit Cards or Car Loan payments?
more than:	30 days	60 days	90 days	120 days

Are your Credit Card (s) or Car Loan (s) payments currently past due?

Have you ever filed bankruptcy?

If Yes:

What Type (Chapter)?

Has it been discharged?

If Yes, What was the date of discharge? (month/year)

If No, What is the balance owing?


Employment
	Borrower		Co-Borrower
Name and Address of Employer. (Including Self-Employment)

How many years in:	job?	profession?	job?	profession?
Position / Title:
Monthly Income:
If employed in current position for less than two years or .... If currently employed in more than one position, complete the following in blue text.
Name and Address of 2nd Employer. (Including Self-Employment)

How many years in:	job?	profession?	job?	profession?
Position / Title:
Monthly Income:

Name and Address of 3rd Employer. (Including Self-Employment)

How many years in:	job?	profession?	job?	profession?
Position / Title:
Monthly Income:

Assets

List Checking and Savings Accounts.

	Bank Name	Acct. No.	Acct. Type	Acct. Balance
1st
2nd
3rd

List Stocks, Bonds, and 401K's.

	Company Name	Balance
1st
2nd
3rd

List Automobiles Owned.

	Make / Model	Year	Value
1st
2nd
3rd
4th

Liabilities
List the names, Balances, and Minimum Monthly Payments for all: (Credit Cards and Loans other than your Mortgage.)
	Creditor	Balance	Payment

Other Real Estate Owned
Please list any real estate owned other than your primary residence and the subject property.
	Property Address	Mortgage Balance	Monthly Payment	Gross Rent
1st
2nd
3rd

Declaration
Are there any outstanding Judgments against you?
Borrower:	Co-Borrower
Have you had a property Foreclosed on in the past 7 years?
Borrower:	Co-Borrower
Are you obligated to pay alimony or child support?
Borrower:	Co-Borrower
Are you a U.S. Citizen?
Borrower:	Co-Borrower
Are you a U.S. Permanent Resident Alien?
Borrower:	Co-Borrower