Rehab Funding Credit Application

Rehab Funding Loan Application Borrower’s Name:

Co-Borrower’s Name(spouse only):

Home/Mailing Address

Home Phone:

Own

Rent

Cell:

Home/Mailing Address

Home Phone:

Social Security No. Are you a US Citizen? Yes No Date of Birth Married Separated Single # Dependants Ages

Own

Cell:

Social Security No. Are you a US Citizen? Yes No Date of Birth Married Separated Single # Dependants Ages

Employment Information Name & Address of Employer:

Name & Address of Employer:

Self Employed Business Phone Yrs on this job Yrs. In this line of work Position/Type of Business /

Self Employed Business Phone Yrs on this job Yrs. In this line of work Position/Type of Business /

Monthly Income And Housing Expense Information Gross Monthly Income

Borrower

Rent

Co-Borrower

Monthly Housing Expense

Base Income

Rent

Overtime

First Mortgage

Bonuses

Other Financing

Commissions

Hazard Insurance

Dividends/Interest

Real Estate Taxes

Net Rental Income

Mortgage Insurance

Other

Other

Total

Total

Assets And Liabilities Assets

Name & Address of Bank, S&L or Credit Union: Acct. no. Balance: Name & Address of Bank, S&L or Credit Union: Acct. no. Balance: Name & Address of Bank, S&L or Credit Union Acct. no. Balance: Name & Address of Bank, S&L or Credit Union: Acct. no. Balance: Stocks & Bonds (Company name/number & description): Life Insurance net cash value Face amount Subtotal Liquid Assets Real estate owned (enter market value from schedule of real estate owned) Net worth of business(es) owned (attaché financial statement)

Liabilities

Name and Address of Company: Acct. no. Mo. Payment Unpaid Balance Name and Address of Company: Acct. no. Mo. Payment Unpaid Balance Name and Address of Company: Acct. no. Mo. Payment Unpaid Balance Name and Address of Company: Acct. no. Mo. Payment Unpaid Balance Name and Address of Company: Acct. no. Mo. Payment Unpaid Balance Name and Address of Company: Acct. no. Mo. Payment Unpaid Balance Alimony/Child Support/Separate Maintenance Payments Owed to Job Related Expense (child care, union dues etc.) Total monthly Payments

Other Assets (itemize) Total

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Representations and Warranties The information contained in this statement is provided to induce you to extend or to continue the extension of credit to the undersigned or to others upon the guarantee of the undersigned. The undersigned acknowledge and understand that you are relying on the information provided herein in deciding to grant or continue credit or to accept a guarantee thereof. Each of the undersigned represents warrants and certifies that the information provided herein is true, correct and complete. Each of the undersigned agrees to notify you immediately and in writing of any change in name, address, or employment and of any material adverse change of the under signed to perform its (or their) obligations to you. In the absence of such notice or a new and full written statement, this should be considered as a continuing statement and substantially correct. If the undersigned fail to notify you as required above, or if any of the information herein should prove to be inaccurate or incomplete in any material respect, you may declare the indebtedness of the undersigned or the indebtedness guaranteed by the undersigned, as the case may be, immediately due and payable. You are authorized to make all inquiries you deem necessary to verify the accuracy of the information contained herein and to determine the credit-worthiness of the undersigned. Each of the undersigned authorizes you to answer questions about your credit experience with the undersigned. As long as any obligation or guarantee of the undersigned to you is outstanding, the undersigned shall supply annually an updated financial statement. This personal financial statement and any other financial or other information that the undersigned give you shall be our property.

________________ Date ________________ Date

____________________________________________ Your signature ____________________________________________ Co-Applicant’s Signature

I hereby authorize Rehab Funding and/or any of its agencies to verify the above credit information as may be required for the extension of credit. __________ Date

______________________________ Signature

____________ SSN

The below signed individual(s) authorize Rehab Funding and/or any of its agencies to verify the above credit information and to obtain a credit history as may be required for the extension of credit.

__________ Date

______________________________ Signature

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____________ SSN