Full Name:
E-Mail:
Contact Number (phone)
Borrower Total Gross Monthly Income: $
Salary
Commission
Overtime: $ included in number above? YesNo
Bonuses: $ included in number above? YesNo
Length of Time on Current Job? years
Length of Time in Profession? years
CoBorrower Total Gross Monthly Income: $
Monthly Debt Obligations:
$ / month OwnRent
$ /month Automobile LoanMajor Credit Cards(Visa, etc.)Store Credit Card (Sears, Macy's, etc.)Child Support and AlimonyStudent LoansInstallment Loans(Bank Loans, etc.)Finance Company Loans $ Total Owed
Amount of Money Available for Down Payment? $
Have You Had Any Late Payments, Charge Offs, Collections, or Judgements within the last 24 months? YesNo
Have You Been Declared Bankrupt Within the Last Ten Years? YesNo
Have You Filed a Chapter 13 Debtor's Court Within the Last Ten Years? YesNo
Have You Had Property Foreclosed on in the Last Ten Years? YesNo
Are You a Party to a Lawsuit? YesNo
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3499 Independence DriveBirmingham, Alabama 35209http://www.gaglianomtg.comPhone (205) 871-4409Fax (205) 871-4410e-mail: gagmtg@gaglianomtg.com
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