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Cross Country Mortgage
8150 Brook River Drive
Suite S-303
Dallas, Texas 75247

Local 214-630-7500

Toll free 800-276-3580

Fax 214-630-7600

Equal Opportunity Housing Lender

Applicant & Co-Applicant Information:

Applicant First Name

Applicant Last Name

Home Phone

Work Phone

Mobile Phone

Address

City

State

Zip

Length of Time

Social Security #

E-Mail Address

Co-Applicant First Name

Co-Applicant Last Name

Home Phone

Work Phone

Mobile Phone

Social Security #

E-Mail Address

Address

City

Length of Time

State

Zip

Gross Income:

1.	Applicant Employer Position Years on Job Years in same field	Monthly Income Amt. $
2..	Co-Applicant Employer Position Years on Job Years in same field	Monthly Income Amt. $
3.	Other Income Applicant (Social Security, Child Support, 2nd Job)	Monthly Income Amt $
4.	Other Income Co-Applicant (Social Security, Child Support, 2nd Job)	$

Total Gross Monthly Income:		$

Type of Loan Requested:

Loan Type:
Residence Type:
Property Type:
Loan Type:
Estimated Loan Amount:	$

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Comments:

* "I authorize Cross Country Mortgage to obtain my/our credit report for the purpose of determining eligibility for a mortgage loan. The information that is obtained is strictly confidential.

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