PRINT this form and fax it to (859) 260-1955

Borrower 1:_______________________________ D.O.B._______________________
Social Security #:__________________________

Borrower 2:_______________________________ D.O.B._______________________
Social Security #:__________________________

Street Address:_________________________________________________________
City:____________________________________ State:_________________________
Zip:_____________________________________ How long?_____________________

Monthly Income for Main Borrower:$_________________________________________
Home Telephone # (w/Area Code): _________________________________________
Work Telephone # (w/Area Code): __________________________________________
Email Address: ________________________________________________________

Please be sure all information is PRINTED and READABLE! Thanks!

Main Borrower's Employer:___________________ How long employed?____________

Monthly Income for Co-Borrower: $__________________________________________

Co-Borrower's Employer:_____________________ How long employed?___________

Amount Available for Down Payment: $_______________________________________

I/We grant permission to Central Kentucky Lending to obtain my credit report.

Signature (Borrower):________________________ Date:_____________________

Signature (Co-Borrower):_____________________ Date:_____________________