1402 Ttt Street, Wasco, GA 93280

Phone: 66{-758-3OO3 Faxr 661-758-3670

Borrower

lnformation/lnformaci6n

Co'Borrower lnformation/Co'aplicante

de solicitante del prEstamo

Name/ Nombre
Date of Birth/ Fecha de

Name/ Nombre
Date of Birth/ Fecha de

nacimiento Social Sec. #/ No. De seour0 Home Cell Phone/ No. De telephono Address/Direccion City-Zip CodeiCiudadC6digo postal
Own-RenV propietario-

nacimiento Social Sec, #/ No. De seour0 Home Cell Phone/ No. De telephono Address/Direccion City-Zip Code/CiudadC6digo postal
Own-RenU propietario-

renta

renta

Employment lnformation/ lnformaci6n de Empleo

Cunrent Employer/ CTE.
Emoleo

Positioni
Posicion

Address/Direccion

Years at current job/ Anos con CTE emoleo

Gross

City-Zip

Code/CiudadC6dioo oostal

lncome/lngresos
total

Notes:

**Borrower Authorization: I hereby authorize the lender/broker to order a consumer credit report and verify The information other credit information. lt is understood that a copy of this form will serve as authorization' for a mortgage loan'** my apptication processing of in ihe used be wilt only obtains, lender/broker that the

X
Borrower/solicitante del prdstamo

X
Co-Borrower/Co-aPl icante