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Purpose of Loan:
Property will be:

Borrower's Name:
Social Security Number:
Date of Birth:
Present Address:
Do you:
No. of Dependents:
Name & Address of Employer:
Position/TitIe/Type of Business:
Years on this job:
Yrs. employed in this line of Work/profession:
Business Phone:
Base Empl. Income:

Co-Borrower Name:
Co-Borrower Social Security Number:
Co-Borrower Phone:
Co-Borrower Date of Birth:
Co-Borrower Select:
Co-Borrower Name & Address of Employer:
Co-Borrower do you:
Co-Borrower No. of Dependents:
Dependent Ages:

If you answer "Yes" to any questions a through i, please use comments box below for explanation.
a. Are there any outstanding judgements against you?    
b. Have you been declared bankrupt within the past 7 years?
c. Have you had property foreclosed upon or given title
or deed in lieu thereof in the last 7 years?
e. Have you directly or indirectly been obligated on
any loan which resulted in foreclosure, transfer
of title in lieu of foreclosure, or judgment?
d. Are you part of a lawsuit?
i. Are you a co-maker or endorser on a note?
f. Are you presently delinquent or in default on any Federal
debt or any other loan, mortgage,
financial obligation, bond or loan guarantee?
If “Yes” give details as described in the preceding question.
g. Are you obligated to pay alimony, child support,
or separate maintenance?
j. Are you a U.S. citizen?
k. Are you a permanent resident alien?
I. Do you intend to occupy the property as your primary
If “Yes,” complete question m below.
m. Have you had an ownership interest in a property
in the last three years?
(1) What type of property did you own?
h. Is any part of the down payment borrowed?
(2) How did you hold title to the home?

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  • Assured Capital Funding
    1165 Monroe St
    Dearborn, MI 48124
  • info@ourfirstloan.com
    (313) 730-9800 Office
    (313) 731-0580 Fax