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Within the last 24 months have you had any late payments on your mortgage? ?? No Yes If yes, continue, otherwise skip to section B.

Within the last 12 months Between 13 & 24 months ago 30-59 days late ?? 0 1 2 3 4 5 6 7 8 9 10 11 12 30-59 days late ?? 0 1 2 3 4 5 6 7 8 9 10 11 12 60-89 days late ?? 0 1 2 3 4 5 6 7 8 9 10 11 12 60-89 days late ?? 0 1 2 3 4 5 6 7 8 9 10 11 12 90+ days late ?? 0 1 2 3 4 5 6 7 8 9 10 11 12 90+ days late ?? 0 1 2 3 4 5 6 7 8 9 10 11 12

?? No Yes

Have you had any late payments on your credit cards, auto loans, student loans or any other consumer debts? ?? No Yes If yes, continue, otherwise skip to section C.

Within the last 12 months Between 13 & 24 months ago 30-59 days late ?? 1 2 3 4 5 6 7 8 9 10 11 12 30-59 days late ?? 1 2 3 4 5 6 7 8 9 10 11 12 60-89 days late ?? 1 2 3 4 5 6 7 8 9 10 11 12 60-89 days late ?? 1 2 3 4 5 6 7 8 9 10 11 12 90+ days late ?? 1 2 3 4 5 6 7 8 9 10 11 12 90+ days late ?? 1 2 3 4 5 6 7 8 9 10 11 12

?? No Yes

Do you have any collections, charge offs, judgments or tax liens? ?? NO Yes, within the last month Yes, within the last 3 months Yes, within the last 6 months Yes, within the last 1 year Yes, within the last 2 years Yes, within the last 3 years Yes, within the last 4 years Yes, within the last 5 years Yes, within the last 6 years Yes, more than 7 years ago

Have you been bankrupt during the last 7 years? ?? No bankruptcies over the last 7 years Currently in bankruptcy Bankruptcy discharged less than 3 months ago Bankruptcy discharged less than 6 months ago Bankruptcy discharged over 1 year ago Bankruptcy discharged over 2 years ago Bankruptcy discharged over 3 years ago Bankruptcy discharged over 4 years ago Bankruptcy discharged over 5 years ago Bankruptcy discharged over 6 years ago Bankruptcy discharged over 7 years ago

Have you had any foreclosures during the last 7 years? ?? No foreclosures Currently in foreclosure Had a foreclosure less than 3 months ago Had a foreclosure less than 6 months ago Had a foreclosure less 1 year ago Had a foreclosure less 2 years ago Had a foreclosure less 3 years ago Had a foreclosure less 4 years ago Had a foreclosure less 5 years ago Had a foreclosure less 6 years ago Had a foreclosure less 7 years ago Had a foreclosure more than 7 years ago

Do you have a lot of consumer debts, such as credit cars, auto loans, student loans, etc.? ?? I pay my credit cards in full every month I have some debts, but I am managing ok My debts are excessive, I need help I have no credit cards, car loans or student loans

The value or sales price of house is $ The amount of loan desired on house is $