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Section A: Mortgage Lates
Within the last 24 months have you had any late payments on your mortgage?
??
No
Yes
If yes, continue, otherwise skip to section B.
Number of Mortgage Lates
Within the last 12 months
Between 13 and 24 months ago
30-59 days late
??
0
1
2
3
4
5
6
7
8
9
10
11
12
30-59 days late
??
0
1
2
3
4
5
6
7
8
9
10
11
12
60-89 days late
??
0
1
2
3
4
5
6
7
8
9
10
11
12
60-89 days late
??
0
1
2
3
4
5
6
7
8
9
10
11
12
90+ days late
??
0
1
2
3
4
5
6
7
8
9
10
11
12
90+ days late
??
0
1
2
3
4
5
6
7
8
9
10
11
12
Are you currently late on your mortgages?
??
No
Yes
Section B: Consumer Loan Late
s
Have you had any late payments on your credit cards, auto loans, student loans or any other consumer debts?
??
No
Yes
If yes continue, otherwise skip to section C.
Number of Consumer Lates
Within the last 12 months
Between 13 and 24 months ago
30-59 days late
??
1
2
3
4
5
6
7
8
9
10
11
12
30-59 days late
??
1
2
3
4
5
6
7
8
9
10
11
12
60-89 days late
??
1
2
3
4
5
6
7
8
9
10
11
12
60-89 days late
??
1
2
3
4
5
6
7
8
9
10
11
12
90+ days late
??
1
2
3
4
5
6
7
8
9
10
11
12
90+ days late
??
1
2
3
4
5
6
7
8
9
10
11
12
Are you currently late on your consumer loan payments?
??
No
Yes
Section C: Collections, Charge offs, Judgements, Tax Lien
Do you have any collections, charge offs, judgements or tax liens?
??
No
Yes, within the last month
Yes, within the last 3 months
Yes, within the last 6 months
Yes, within the last 1 year
Yes, within the last 2 years
Yes, within the last 3 years
Yes, more than 4 years ago
Section D: Bankruptcies
Have you been bankrupt during the last 7 years?
??
No bankruptcies over the last 7 years
Currently in bankruptcy
Bankruptcy discharged less than 3 months ago
Bankruptcy discharged less than 6 months ago
Bankruptcy discharged over 1 year ago
Bankruptcy discharged over 2 years ago
Bankruptcy discharged over 3 years ago
Bankruptcy discharged over 4 years ago
Bankruptcy discharged over 5 years ago
Bankruptcy discharged over 6 years ago
Bankruptcy discharged over 7 years ago
Bankruptcy discharged over more than 7 years ago
Section E: Foreclosures
Have you had any foreclosures during the last 7 years?
??
No foreclosures
Currently in foreclosure
Had a foreclosure less than 3 months ago
Had a foreclosure less than 6 months ago
Had a foreclosure less than 1 year ago
Had a foreclosure less than 2 years ago
Had a foreclosure less than 3 years ago
Had a foreclosure less than 4 years ago
Had a foreclosure less than 5 years ago
Had a foreclosure less than 6 years ago
Had a foreclosure less than 7 years ago
Had a foreclosure more than 7 years ago
Section F: Payment load
Do you have a lot of consumer debts, such as credit cards, auto loans, student loans, etc.?
??
I pay my credit cards in full every month
I have some debts, but I am managing ok
My debts are excessive, I need help
I have no credit cards, car loans or student loans
Section G: Equity in your property
The value of my house is $
The total amount of loans on my house are $
Supreme Lending
- 9514 Console Suite 101 - San Antonio, TX 78229
Office Phone:
(210) 692-7500
Fax:
(210) 692-7528
Cell Phone:
(210) 421-3479
Toll Free Phone:
877-692-3863
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Loan product availability is subject to loan amount and qualification of borrower. Not every applicant qualifies or is eligible for every loan program. Some products may not be available in all states. Loan approval and rate are dependent on borrower credit, collateral, and financial history. All loan programs, terms and rates are subject to change without notice. Arkansas Mortgage Banker and Broker License #12046. Licensed by Department of Corporations under the California Residential Mortgage Lending Act License #4130655. Connecticut Mortgage Lender License - 1st: #196266, 2nd: #20111. District of Columbia Mortgage Dual Authority Licensee #MLB 6594. Florida Correspondent Mortgage Lender License #0702753. Georgia Residential Mortgage License #22114. Iowa Mortgage Banker/Broker License #MBK-2005-0240. Idaho Mortgage Broker/Lender License #MBL-6118. Illinois Residential Mortgage License #MB.6760323. Kansas Mortgage Company License #2006-5069. Louisiana Lender License #RML 1615. Maryland Lender License #11795. Michigan Broker License #FL-0012745. Minnesota Residential Mortgage Originator License #20618876. Mississippi License # ML/903941/2009. Missouri Residential Mortgage Licensee. Nebraska Mortgage Banker License #1965. New Mexico Lender/Broker License #1713. North Carolina Lender License #L-122702. North Dakota Money Broker License #MB101798. Ohio Mortgage Lender License #MB.803730. Oregon Lender License #ML-4265. South Carolina Supervised Lender License #S-5, 839. South Dakota Mortgage Lender License #4811. Tennessee Mortgage Banker/Broker License #3101. Texas Mortgage Banker Registration #45194 at 17290 Preston Road, Suite 300, Dallas, TX 75252. Utah Mortgage Lender License #5868484-MLCO. Licensed by the Virginia State Corporation Commission #MLB1329. Washington Consumer Loan License #520-CL-50148. Wisconsin Mortgage Banker License #214616. Wyoming Mortgage Lender License # 960. © 2009 Everett Financial, Inc. dba Supreme Lending. All rights reserved. © 2009 Everett Financial, Inc. dba Supreme Lending at 17290 Preston Rd., #300, Dallas, TX 75252. All rights reserved.
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