Test Page Client 1 InformationName* First Middle Last SSN* Date of Birth* MM slash DD slash YYYY Home Phone Number*Cell Phone NumberEmail Address Marital Status* Single Married Separated Divorced If separated, we will need a copy of the agreement. Drop files here or Select files Max. file size: 512 MB. Upload a copy of your separation agreement.Number of Years of School*Number of Dependents*Present Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Do you own or rent at your present residence? Own Rent Years in residence? If less than two years at present address, provide your previous address.Previous Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Did you own or rent your former residence?* Own Rent Years in former residence?Do you get paid:* Weekly Every 2 weeks Twice a month Monthly When did you start this job? Client 1 Income*Gross Monthly IncomeSelf Employed IncomeChild Support/Alimony IncomeSocial Security/Disability IncomeBank Interest & Dividend IncomeGift IncomeWill there be another client on the application? Yes No Client 2 InformationONLY FILL OUT THIS SECTION IF YOU ARE GOING TO BE ON THE LOAN.Name* First Middle Last SSN* Date of Birth* MM slash DD slash YYYY Home Phone Number*Email Address Cell Phone NumberMarital Status* Single Married Separated Divorced If separated, we will need a copy of the agreement. Drop files here or Select files Max. file size: 512 MB. Upload a copy of your separation agreement.Number of Years of SchoolNumber of DependentsPresent Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Do you own or rent at your present residence? Own Rent Years at residence?Former Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Did you own or rent your former residence? Own Rent Years in former residence?Do you get paid: Weekly Every 2 weeks Twice a month Monthly When did you start this job? Client 2 IncomeGross Monthly IncomeSelf Employed IncomeChild Support/Alimony IncomeSocial Security/Disability IncomeBank Interest & Dividend IncomeGift IncomeHouseholdPLEASE FILL OUT THIS SECTION FOR EVERYONE IN THE HOUSEHOLD THAT HAS INCOME AND IS NOT GOING TO BE ON THE LOAN.First NameLast NameGross Monthly IncomeSelf Employed IncomeChild Support/Alimony IncomeSocial Security/Disability IncomeBank Interest & Dividend IncomeGift Income Present Housing ExpenseIf applicable, combine Client 1 and Client 2Current Rent:* Do you currently live in subsidized housing?based on income Yes No Monthly DebtNot to include food, clothes, utilities, daycare, etc. Combine Client 1 and Client 2Car PaymentLoan PaymentCredit Card PaymentStudent LoanOtherGovernment ReportingEthnicity of Head of Household Not Hispanic / Latino Hispanic / Latino Single Race White/Caucasian White/Blake Black/African American American Indian/Alaska Native Asian Native Hawaiian/Other Pacific Islander Other Multiple Race Multi-Race Black/African American and White American Indian/Alaska Native and White Asian and White American Indian/Alsaka Native and Black Asian and Black/African American Liquid AssetsDo you have a savings account? Yes No How much is in your savings account? Do you have any stocks/bonds/money markets? Yes No How much do you have in stocks/bonds/money markets? Will anyone be giving you gift of funds? Yes No How much will you be receiving as a gift? Do you have an inheritance? Yes No How much is your inheritance? County/City you wish to purchase in? Cash you have available for down payment: DeclarationsClient 1Client 1: Does the client intend to occupy the property as his/her primary residence? Yes No Client 1: Has the client had an ownership interest in a property in the last 3 years? Yes No Client 1: Has the client been declared bankrupt within the past 7 years? Yes No Client 1: Has the client had property foreclosed upon or given title or deed in lieu thereof in the past 7 years? Yes No Client 1: What is client's citizenship? US Citizen Perm Resident Alien Non-perm Resident Alien Client 2Client 2: Does the client intend to occupy the property as his/her primary residence? Yes No Client 2: Has the client had an ownership interest in a property in the last 3 years? Yes No Client 2: Has the client been declared bankrupt within the past 7 years? Yes No Client 2: Has the client had property foreclosed upon or given title or deed in lieu thereof in the past 7 years? Yes No Client 2: What is client's citizenship? US Citizen Perm Resident Alien Non-perm Resident Alien List all family members in house, including yourselfNameAgeDo they work? All adults over 18 must also be listed, even if they are not going to be on the loan!How did you hear about BRHN? Friend Realtor Loan Officer Newspaper Radio Website TV Other If other, where did you hear about BRHN? ConsentClient 1 Consent* I consentI/We fully understand that it is a Federal crime punishable by fine or imprisonment, or both, to knowingly make any false statements concerning any of the above facts as applicable under the provisions of Title 18, United States Code, Section 1001, et seq.Client 1 Consent Date* MM slash DD slash YYYY Client 2 Consent* I consentI/We fully understand that it is a Federal crime punishable by fine or imprisonment, or both, to knowingly make any false statements concerning any of the above facts as applicable under the provisions of Title 18, United States Code, Section 1001, et seq.Client 2 Consent Date* MM slash DD slash YYYY Monthly Spending PlanNumber of Adults in household? Number of Children in household? Net Monthly IncomeSource 1Source 2OtherTOTAL NET MONTHLY INCOME (A)Fixed ExpensesRentElectricGas/OilWater/SewerTelephone (Basic)Telephone (Long Distance)Telephone (Cellular)Trash PickupCable/InternetAuto Payment(s)Auto InsuranceLife InsuranceRenter InsuranceChild Support/AlimonyMedical InsuranceChild CareOtherTOTAL FIXED EXPENSES (B)Creditor PaymentsInstallment LoansCreditor NameMonthly Payment Credit Card PaymentsCreditor NameMonthly Payment TOTAL CREDITOR PAYMENTS (C)Flexible ExpensesSavingGroceriesLunch (work/school)Eating OutEntertainment/HobbiesLaundry/Dry CleaningCleaning SuppliesClothingGasoline/Bus/TaxiNewspaper/MagazineAlcohol/CigarettesChurch/CharityTuition/BooksBarber/Beauty ShopAuto MaintenanceHouse MaintenanceDoctor/DentistPresecriptionsPetsParking/TollsLottery/BingoOtherTOTAL FLEXIBLE EXPENSES (D)EXPENSESTOTAL EXPENSES (E)Fixed(B) + Creditor(C) + Flexible(D)Difference (+ or -)Net Monthly Income(A) - Total Expenses(E)Monthly Spending Plan ConsentApplicant 1* Check to indicate as signatureApplicant 1 Signature Date MM slash DD slash YYYY Applicant 2* Check to indicate as signatureApplicant 2 Signature Date MM slash DD slash YYYY File Uploads Drop files here or Select files Max. file size: 512 MB. Δ