PAUL PIFFARD'S Home selling System

"Call Paul & Start Packin"

4112 Petrolia Line, Ontario, Canada
Toll-Free: (877) 542-9992
Direct: (519) 882-2950
Fax: (519) 882-4948
E-mail: ppiffard@xcelco.on.ca

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Mortgage Application

REAL ESTATE
Financial Information Sheet

Purchaser Information:

Purchaser (Full Name):
Age:
Soc. Security #:
Residence Phone #:
Business Phone #:
Present Address:
Years at Present Address:		Own $ or
		Rent $/month

Previous Address:

Marital Status:	Married Separated Unmarried (including single, divorced, or widowed)

Occupation: (Position & Title)
# of years:
Place of Employment: (Name & Address)
Previous Employer: (Name & Address)

Co-Purchaser Information:

Co-Purchaser (Full Name):
Age:
Soc. Security #:
Residence Phone #:
Business Phone #:
Present Address:
Years at Present Address:		Own $ or
		Rent $/month

Previous Address:

Marital Status:	Married Separated Unmarried (including single, divorced, or widowed)

Occupation: (Position & Title)
# of years:
Place of Employment: (Name & Address)
Previous Employer: (Name & Address)

Gross Annual Income:

	Purchaser	Co-Purchaser
Self-Employed ?	Yes No	Yes No
Base Salary:	$	$
Overtime:	$	$
Bonuses:	$	$
Commissions:	$	$
Dividends:	$	$
Net Rental Income:	$	$
Other:	$	$

Total:	$	$

Do You Intend To Occupy This Property ? Yes No
Number of Children:
Ages:
Other Dependents:

Assets:

Liabilities:

(List outstanding obligations including auto loans, mortgage payments,credit cards, personal loans, and all other loans.)

Type	Creditor's Name	Unpaid Balance		Due Date	Monthly Payment
		$			$
		$			$
		$			$
	Total:	$			$

Additional Monthly Obligations:
Alimony:		$
Child Support:		$
Child Care:		$


Are There Any Judgements or Lawsuits Present?			Yes No
Amount:			$

Is Any Part of the Down Payment or Settlement Costs Being Obtained From a Source Other Than From Assets Listed Above?			Yes No

4112 Petrolia Line, Petrolia, Ontario, Canada
Toll-Free: (877) 542-9992
Direct: (519) 882-2950
Fax: (519) 882-4948
E-mail: ppiffard@xcelco.on.ca