Interbanc Mortgage Services - IMS Questionnaire

To make it easy to apply, this questionnaire asks you the information needed on the application.

Please complete this questionnaire in its entirety. Once completed please sign the Questionnaire and return it to InterBanc Mortgage Services with the signed Loan Application Form (including the completed Section X), the Authorization Form and the items on the Document Checklist.

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What is your name? (Include Jr. or Sr. if applicable.)

_________________________

If residing at present address for less than two years, what was your former address?

_______________________________________________________

_______________________________________________________

______________________________________________________

______________________________________________________

If you have been employed in current position for less than two years or if currently employed in more than one position, provide the name and address of employer.

______________________________________________________________

What dates were you employed?______________

What was your monthly income?______

What was your position/type of business? _________________

Telephone number?______

Do you have income from other sources? ________

If yes, please describe the source and what is the monthly amount?

If you are applying with another person, please complete the following for the co-borrower:

What is your name? (Include Jr. or Sr. if applicable.) __________________________

Do you have a social security number? If yes, provide number ___________________

If residing at present address for less than two years, what was your former address?

_______________________________________________________________

Did you rent or own your former address?____________

If you have been employed in current position for less than two years or if currently employed in more than one position, provide the name and address of employer.

Do you have income from other sources? ________

If yes, please describe the source and what is the monthly amount?
_________________________________________________

Please list your checking, savings or other accounts where your assets may be verified:

Name:____________________________________________________________

Address: __________________________________________________________

Name: ___________________________________________________________

Address: _________________________________________________________

Name: ____________________________________________________________

Address: __________________________________________________________

Name:____________________________________________________________

Address: __________________________________________________________

Please list any auto loans, installment loans, mortgage loans, revolving charge accounts, alimony, child support, etc. with outstanding balances:

Amount of Mortgages __________ Payment ___________

Gross Rental Income ______________

Amount of Mortgages ___________ Payment ___________

Gross Rental Income ______________

Amount of Mortgages ____________ Payment ___________

Gross Rental Income ______________

Amount of Mortgages __________ Payment ___________

Gross Rental Income _______________

Are there any outstanding judgments against you?	Borrower ____	Co-Borrower ____
Have you been declared bankrupt within the past 7 years?	Borrower ____	Co-Borrower ____
Have you had property foreclosed upon or given title or deed in lieu thereof in the past 7 years?	Borrower ____	Co-Borrower ____
Are you a party to a lawsuit?	Borrower ____	Co-Borrower ____
Have you directly or indirectly been obligated on any loan which resulted in foreclosure or judgment, including such loans as home mortgage loans, SBA loans, home improvement or education loans?	Borrower ____	Co-Borrower ____
Are you obligated to pay alimony or child support?	Borrower ____	Co-Borrower ____
Is any part of the down payment borrowed?	Borrower ____	Co-Borrower ____
Are you a co-maker or endorser on a note?	Borrower ____	Co-Borrower ____
Are you a U.S. citizen?	Borrower ____	Co-Borrower ____
Are you a permanent resident alien?	Borrower ____	Co-Borrower ____
Do you intend to occupy the property as your primary residence?	Borrower ____	Co-Borrower ____
If yes, complete the following question: Have you had an ownership interest in property in the past 3 years?	Borrower ____	Co-Borrower ____
If yes, what type of property did you own- principal residence, second home or investment?	Borrower ____	Co-Borrower ____
How did you hold title to the home-by yourself, with your spouse or jointly with another person?	Borrower ____	Co-Borrower ____

Return this questionnaire to:
InterBanc Mortgage Services
237 Lookout Place - Second Floor
Maitland, FL 32751 USA

1. Signed Loan Application Form (including the completed Section X)
2. Authorization Form
3. Items on the Document Checklist

______________________________	______________________________
Borrower's Signature	Date

______________________________	______________________________
Co-Borrower's Signature	Date