Client Questionnaire

Rebecca R. Madej, NMLS #91445

Mortgage Consultant Cunningham & Company Mortgage Bankers 2101 Rexford Road, Suite 131E; Charlotte, NC 28211 Office: 704.366.7711 | Mobile: 704.488.8883 | Fax: 704.366.8822
Your responses to this questionnaire authorize us to use credit reporting information for the purpose of this pre-qualification. It will help me evaluate your short and long term goals and allow me to recommend the best mortgage strategy to meet your needs. The information provided is for my use only and is kept confidential. Please complete and return via fax or email. All of us at Cunningham & Company look forward to providing you with our finest service and we appreciate the opportunity be of assistance.

Referred By:

_____________________________

Purchase:

Refinance:

Borrower Information
Complete Name (incl. Jr, Sr, etc. if applicable)

Coborrower Information
Complete Name (incl. Jr, Sr, etc. if applicable)

Social Security Number: Call me to provide SSN Email: Date of Birth:

Home Phone: Cell Phone:

Social Security Number: Call me to provide SSN Email: Date of Birth:

Home Phone: Cell Phone:

Number of Yrs in School:

Number of Yrs in School:

Marital Status:
Married - Separated - Unmarried (Single, Divorced or Widowed)

Marital Status:
Married - Separated - Unmarried (Single, Divorced or Widowed)

Dependents: (Not listed by co-applicant): Name(s): (Date of Birth/Age):

Dependents: (Not listed by co-applicant): Name(s): (Date of Birth/Age):

Residency History
Address (Street, City, State, Zip): Own/Rent: From -- To: Monthly Payment/Rent:
$__________ $__________ Monthly Payment/Rent: If residing at present address for less than 2 years, please complete the following to give a full 2 years residency history:

Address (Street, City, State, Zip):

Own/Rent: From -- To:

Address (Street, City, State, Zip):

Own/Rent: From -- To:

Address (Street, City, State, Zip):

Own/Rent: From -- To:

Monthly Payment/Rent:

$__________

Monthly Payment/Rent:

$__________

Employment History
Name of Current Employer: Y/N
Commissioned? Dates of Employment:

Name of Current Employer: Y/N

Commissioned?

Dates of Employment:

Self-Employed?

Y/N

Self-Employed?

Y/N

Gross Monthly Income:

Yrs Employed in Profession:

Gross Monthly Income:

Yrs Employed in Profession:

Position/Type of Business

Business Phone

Position/Type of Business

Business Phone

If employed in current position for less than 2 years, please complete the following to give a full 2 years employment history: Dates of Dates of Employment: Name of Previous Employer: Employment: Name of Previous Employer:

Self-Employed? Gross Monthly Income:

Y/N

Commissioned?

Y/N

Self-Employed? Gross Monthly Income:

Y/N

Commissioned?

Y/N

Yrs Employed in Profession:

Yrs Employed in Profession:

Position/Type of Business

Business Phone

Position/Type of Business

Business Phone

Asset Information
Name of Bank or Financial Institution Checking Ch ki account with: t ith Savings/Money Market account with:
Balance:

Name of Bank or Financial Institution Investments with: I t t ith 401k/IRA account with:

Balance:

Current Property Information

Complete Property Address: (please note if pending sale)
Primary(P) 2nd Home (V) Rental (R)

Type of Property (Single Family, Condo, Etc.)

Market Value of Property

Rental Income (if applicable)

Key Advisors
Throughout the loan process, additional information may be needed from your key advisors.

Name and Company: Realtor: Insurance Agent: Financial Planner: CPA/Tax Professional:

Phone:

Fax:

Email:

Mortgage Strategy
New Property Information: Address:
Close Date: Earnest Money: Seller Paid CC: Purchase Price:

Refinance Information:

Amount owed on current mortgage(s):

Est. Taxes:

Close Date: Current Value: Original Cost: Est. Insurance We believe that financing and acquiring real estate is an integral part of your overall financial plan. To assist us in selecting the most appropriate and cost effective mortgage strategy for your individual needs, please complete the following questions.

1. What is your monthly payment objective? 3. In what price range are you looking? 5. How many years do you think you will live in this home?
1-5 years 5-10 years 10+ years

2. What is your desired down payment? 4. What type of loan would you like? 6. Would you like to pay your insurance and taxes monthly with your payment (have an escrow account)? 8. Do you have life insurance to protect your home?
If so, how much and what type?

7. Ideally, how old would you like to be when your home loan is paid off? 9. What is your timeline expectation to have this mortgage finalized?

10. Have you purchased a home before? If so, when?

Since we hope you become a client for life and we believe in creating 'Raving Fans', we'd like to know a little more about you!

Additional Information

What is your hometown? What are your pets names? pets' Is there anyone else involved in this decision with you? If so, who?

What is your favorite sports team? What are your hobbies? What is the best time of day to reach you?

What would you like to drink at your consultation? Coke:_______ Diet Coke: _______ Sprite: _______ Bottled Water:_______ Coffee: _______

Notes/Comments
Is there any additional information we need to know about you?