Here is a form I use with my clients...

Hope it help any of you who may need it

Travis

CUSTOMER PROFILE

Referral Source (How did you hear about us?): _____________________________________

Date:     Appt. Date:         Appt. Time: 

Borrower Name:          Borrower Name:
Social Security No.:         Social Security No.:
Address:           Home Phone:  (      )
           Work Phone:   (      )
           Email: ______________________________

Employed at: ________________________     Employed at:_________________________
Where:           Where:
How Long:          How Long:
Income:           Income:
(40 Hrs?)   Hourly, Salary, Commission?     (40 Hrs?)   Hourly, Salary, Commission?
Addl. Income:         Addl. Income:
   Alimony, Child Support, Soc. Sec.?    Alimony, Child Support, Soc. Sec.?

Home Value:          L.C. (      )   MTG. (      )  Status
Home Type (Single Family, Condo, etc): _________________________________________
Annual Taxes:          Annual Hazard Insurance: _______________
Mortgage Balance:   Rate:       Other:  
Current debts:          Credit Problems:

Purpose:           Amount Requested:
Goals:              Programs Discussed:
              Rates Quoted:      

Notes: