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  • Lon C. Hill Building
    502 East Tyler Ave.
    Harlingen, Texas  78550
    Office Phone #: (956) 216-5180
    Fax #: (956) 216-5168


Borrower's Name:
Mailing Address: Address, City, and State
Home/Cell #:
E-Mail Address:
Including yourself, how many people will occupy the home?
Comments Heading Please include the following information:
name(s) of other household members,
relationship to borrower,
and employment status (full-time, part-time, student, unemployed)
Are you a Veteran of the United States military?
What is the estimated monthly gross income (before deductions) for each person in your household?
Child Support
Social Security
Total Monthly Income
Lender's Name and Phone Number If you have a lender, please enter the name and phone number of your lender.
Is your credit:

Are you presently delinquent or in default on any Federal debt (including income taxes) or any other loan, mortgage, finanical obligation, bond, or loan guarantee?
Have you ever declared bankruptcy?
Are you a U.S. Citizen or Permanent Resident Alien?
Are you currently delinquent on property taxes (city/school/county)?
Comments Heading If you answered "Yes" to any of the above questions, please provide details, including date, name, and address or Lender, FHA, or VA case number, if any, and reasons for the action.
Co-Borrower's Name:
Work #:
Annual Income
Have you attended an approved 8-hour Homebuyer Education Course?
Are you currently behind on child support or alimony?
Have you lost property foreclosed upon or given title or deed in lieu thereof in the last 7 years?
Have you had ownership interest in a property in the last 3 years?
Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgement? This would include such loans such as home mortgage loans, SBA loans, home improvement loans, education loans, manufactured (mobile) home loans, any mortgage, financial obligation, bond, or loan guarantee.)

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