Mortgage Application Worksheet

Subject Property Information

Property Address: City, State, Zip, County: Year Built: Loan Amount Requested: Purchase Price or Estimated Value
If Refi, what year did you buy it?

Licensed in the states of Illinois and Wisconsin

Estimated Annual Taxes Estimated Annual Ins. Monthly Assessments Est. Close Date Current Mtg /Rent Payment Contact for access to prop: Escrowing for Taxes & Ins?

Type of Loan Requested

Borrower Information
Name: Date of Birth: Social Sec. #: Home Phone # Cell / Alternate Phone # Email Address Marital Status: Dependents: Depend. Ages: Current Address: City, State, Zip Yrs. At Current Add: Yrs. Of Schooling:

Co-Borrower Information
Name: Date of Birth: Social Sec. #: Home Phone # Cell / Alternate Phone # Email Address Marital Status: Dependents: Depend. Ages: Current Address: City, State, Zip: Yrs. At Current Add: Yrs. Of Schooling:

Employment Information (24 months)

Employer Name: Employer Address: City, State, Zip Your Position: Yrs on current job Yrs in line of work Work Phone Number Current Salary

Employment Information Co-Borrower (24)

Employer Name: Employer Address: City, State, Zip Your Position: Yrs on current job Yrs in line of work Work Phone Number Current Salary

Jan Leasure NMLS #213431 -Diamond Residential Mortgage Corporation Phone 847-362-1335 Fax 866-466-7073
jan.leasure@thedrmc.com

Mortgage Application Worksheet

IF EMPLOYED LESS THAN 2 YEARS - Previous Employment Information
Employer Name: Employer Address: City, State, Zip: Your Position: Start Date: Complete Date: Employer's Phone Number Ending Salary: Employer Name: Employer Address: City, State, Zip: Your Position: Start Date: Complete Date: Employer's Phone Number: Ending Salary:

Financial Accounts
Bank Name Type of Account Approx. Balance Bank Name Type of Account Approx. Balance 401 K (company): Approx. Balance: Bank Name Type of Account Approx. Balance Bank Name Type of Account Approx. Balance 401 K (company): Approx. Balance:

Real Estate Owned - Primary Residence

Addresses: City, State, Zip: Value of Property: Mortgage Payment/ Balance: Addresses: City, State, Zip Value of Property: Mortgage Payment/ Balance:

Credit Consent
I, the undersigned consumer, direct Diamond Residential Mortgage Corporation to obtain a copy of my credit report. This consent shall automatically expire thirty (30) days from the date of my signature below.

Name

Date

Fax signed and fully completed application to (847)-362-1347 or email

jan.leasure@thedrmc.com

Name Referred By: ________________________________________

Date

Jan Leasure NMLS #213431 -Diamond Residential Mortgage Corporation Phone 847-362-1335 Fax 866-466-7073
jan.leasure@thedrmc.com

Mortgage Application Worksheet

Jan Leasure NMLS #213431 -Diamond Residential Mortgage Corporation Phone 847-362-1335 Fax 866-466-7073
jan.leasure@thedrmc.com