C.I.F.I

Borrower Information

Social Security Number * Date of Birth * Cell Phone * Email Address * Current Address * City * Years at Current Address * Housing Status * -- Select -- Own Rent Living with Family Monthly Housing Payment *

Employment Information

Current Employer Name * Employer Address Employer Phone Job Title * Years on This Job * Gross Monthly Income * Other Monthly Income Source of Other Income

Co-Borrower Information

Will there be a co-borrower? * No Yes

Property/Loan Information

Property Address (if different) City Year Built Property Type * -- Select -- Single Family Home Manufactured Home 2-4 Unit Property Estimated Current Property Value * Loan Amount Requested * Purpose of Loan * -- Select -- General Repairs/Improvements Energy Efficiency Upgrades Accessibility Modifications Other Contractor Name Contractor License Number

Declarations

Acknowledgment & Agreement

I/We certify that the information provided is true and complete.

Borrower Signature (type full name) * Date * Co-Borrower Signature