Borderplex Real Estate

Applicant, please tell us about yourself:

Name Social Secury # Date of Birth

Phone # (day)

Phone # (eve)

E-Mail Address Present Address

City

State

Zip

Current employment information

Employer Position Gross Monthly Salary $ Number of years List additional income and source (such as alimony or child support): Monthly Payment Desired

Please list your assets: Provide current balance information.

Checking Account(s)	Savings Account(s)	Gift Funds	Retirement (401K, etc.)	Other
$	$	$	$	$

Tell us about your credit:

Are your credit obligations paid as agreed? Yes No

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Finance

Applicant, please tell us about yourself:

Current employment information