LSR Lending Quick Application

Borrower Name     Co-Borrower name

Borrower SSN                       Co-Borrower SSN

Borrower DOB                       Co-Borrower DOB

Current address  

                   City State Zip

Phone  

E-mail address 

Purchase or refinance    If refinance, cashout or rate term

If cashout, how much?

Gross Monthly income

Sales price or, if a refinance, the estimated appraised value

Requested loan amount

Loan Officer's Name (If known)