APPLICATION FOR MORTGAGE LOAN

Applicant ________________________________________________________ S.I.N.# ___________________________

Current Address ___________________________________________________Postal Code _________How Long (Years)______

Home Ph.(___) ____-_______ Business Ph.(___) ____-_______ Pager/Cell_________________________

Previous Address Years _____________________________________________Postal Code _________

Co-Applicant or Guarantor ________________________________________________________S.I.N.# ___________________________

Current Address ___________________________________________________Postal Code _________How Long (Years)______

Home Ph.(___) ____-_______ Business Ph.(___) ____-_______ Pager/Cell_________________________

Previous Address Years _____________________________________________Postal Code _________

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PERSONAL INFORMATION

Marital Status: Com.Law ____ Single____ Married____ Widow(er)____ Divorced____

Applicant -----------------------------------------------------Co-Applicant/Guarantor

1. Birth date_____________________________________ 1.Birth date ________________________________________

2. No. & Ages of Dependents________________________ 2.No. & Ages of Dependents____________________________

3. Employer's Name_______________________________ 3. Employer's Name___________________________________

4. Employer's Address______________________________ 4.Employer's Address ________________________________

5. Business Type/Position ____________________________ 5.Business Type/Position_______________________________

6. No. of Years with Firm____________________________ 6.No. of Years with Firm________________________________

7. Annual Base Salary $_____________________________ 7. Annual Base Salary$_________________________________

8. Other Income $_________________________________ 8. Other Income$______________________________________

9. Total Income $_________________________________ 9. Total Income $______________________________________

10. Previous Employment_________________________________ 10.Previous Employment _______________________________

11. No. of Years in Previous Employment________________ 11. No. of Years in Previous Employmen_______________________

12. Annual Salary in Previous Employment________________ 12.Annual Salary in Previous Employment _______________________

13. Amount of Life Insurance Carried__________________ 13. Amount of Life Insurance Carried____________________________

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References: Visa ___ Master Card ___ Amex ___ Other ___ Other ______________________________________________________

Name & Address of Bank(s) ____________________________________________________________________________________ __________________________________________________________________________________________________________

__________________________________________________________________________________________________________

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FINANCIAL INFORMATION

Assets------------------------------------------------------------------- Liabilities -----------Outstanding Balance -----------Monthly Payments

Cash in Bank $____________________________________ Bank Loans, Etc. $____________________ $ _______________________

Investments Own Business $__________________________/ ______________ $____________________ $ _______________________

Stocks & Bonds $_________________________________/ ______________ $____________________ $ _______________________

R.R.S.P.(s) $_____________________________________/ _______________ $____________________ $ _______________________

Deposit on Property $______________________________/ _______________ $____________________ $ _______________________

Real Estate $_____________________________________/ _______________ $____________________ $ _______________________

G.I.C.(s) $______________________________________ /_______________ $____________________ $ ________________________

Automobiles -----------------------------------------------/ Past Due Income Tax $____________________ $ _______________________

**Make_________________ Yr_____ $_______________/ _______________________________________________________________

**Make_________________ Yr_____ $______________/ Long Term Mortgages $____________________$ _______________________

**Make_________________ Yr_____ $______________/ Long Term Mortgages $____________________$ _______________________

Personal Effects -----------------------------------------------------Past DueProperty Taxes $____________________$ _______________________

**Furnishings, etc. ________________ $______________

**Other Assets___________________ $______________

**Other Assets___________________ $______________

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Office Use Only

Total Assets $_________________________Total Liabilities $______________________ Total Less: Total Liabilities $_______________

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Yes/No

Are you a co-endorser or co-maker on notes? _____ Comment_________________________________________________

Are you a defendant in any legal action? _____ Comment_______________________________________________________

Are there any unsatisfied judgments? _____ Comment__________________________________________________________

Have you ever declared bankruptcy? _____ Comment___________________________________________________________

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Signature is required for credit check ONLY. -----There is absolutley no commitment. INFORMATION HELD IN THE STRICT CONFIDENCE

Dated: _________Applicant Signature_________________________________________________________

Dated: _________Co-Applicant/Guarantor Signature______________________________________________

Our Personal Fax # 382-5466 - / Cover sheet not neccessary. / email: Tom@VictoriaBuyer.com