Jim L. Smith
5746 Marlin Rd, Suite 610
Chattanooga, TN 37411
Office: (423) 779-1050 ext.1051
Fax: (423) 779-1057
Cell: (423) 503-0821

Application Short Form
* Referred by:
 
Personal Data
 
* Borrower Name (including middle initial): Yrs of School:
Co-Borrower (including middle initial): Yrs of School:
 
* Current Address: * City: State: Zip:
How Long (yrs)? Own Rent Monthly Payment:
 
* Borrower SS/ITIN#: Marital Status: * Borrower Date of Birth: Dependents:
Co-Borrower SS/ITIN#: Marital Status: Co-Borrower Date of Birth:
 
Borrower Work Phone: Co-Borrower Work Phone: Home Phone:
Cellular Phone: Email:
 
Employment History
 
Borrower Employer: Position: How Long? Gross Income:
Co-Borrower Employer: Position: How Long? Gross Income:
Additional Monthly Income: Source:
 
Assets
 
Bank: Balance Checking: Balance Savings:
Other Assets: Balance:
Other Assets: Balance:
 
Loan Information
 
Purchase:         Refinance:         Primary:         2nd Home:         Investment 1-2 unit:
Purchase Price: Approx. Value of Home:
Down Payment Available: Approx Proceeds from Sale of current Home (if applicable):
 
Acknowledgement: Each of the undersigned hereby acknowledges Realty Funding Corporation may verify any information contained in this application form for any legitimate business purpose through any source, including a consumer reporting agency.
 

* Electronic Signature of Borrower:

Electronic Signature of Co-Borrower: