Office to receive this worksheet Pensacola Tampa Plant City Lakeland                   Loan Officer to receive this worksheet                   Reason for your loan *       Purchase Refinance Equity Line Other     Down Payment (if purchase)       Amount From       Savings Sale of Other House Gift     Loan term you prefer       15 Year 30 Year Not Sure     Property location and how you intend to use it. *       Primary Residence Second Home Investment Property       City *   State *               Contact Information (Please use the boxes on the left for the primary borrower and the boxes on the right for co-borrower.)       E-mail address *             First Name, Last Name *             Home Phone Number *             Work Phone Number             Fax Number             Your Street Address             City, State, Zip             How long at this address (since month/year)             Own? Rent? Own? Rent?                   Borrower Information       Age             Social Security Number *             Marital Status             Marital Status Unmarried Married Separated Marital Status Unmarried Married Separated                   Employment Information       Present Employer             Start Date (month/date/year)             Gross Monthly Income             Previous Employer (if at present employer less than two years)             Dates Employed (month/year to month/year)             Gross Monthly Income           Additional Income       Other Income Source             How Long Received             Monthly Amount                           Please Note: Alimony, child support, or separate maintenance income need not be revealed if you do not wish it to be considered as a basis for repaying this obligation.                   Total Liquid Assets available for down payment, closing costs, and reserves?       Checking Balance       Savings Balance       Certificate of Deposit       Stocks/Bonds           Total Revolving Debt (Credit Card debt)       Balances Owed Total Monthly Payment                         Total Installment Debt (Debts with regular monthly payments e.g. auto loans)       Balances Owed Total Monthly Payment                   For Refinance loans only, information on your existing mortgage(s):       Type of Loan: FHA VA Conventional       Lender             Monthly Payment Balance Owed             Property Value Account Number           If you have a second loan on your property       Lender             Monthly Payment Balance Owed             Account Number             Do you currently pay private mortgage insurance (PMI)? Yes No       If you do pay PMI, how much do you pay per month?     Thank you for choosing Hallmark Mortgage Services, Inc. Please read and agree to the following before you click on "Submit". I acknowledge and agree that by submitting this worksheet verification or re-verification of any information contained in this worksheet may be made at any time by the Lender, its agents, successors and assigns, either directly or through a credit reporting agency, from any source named in this worksheet, and the original copy of this worksheet will be retained by the Lender. I understand that I may submit this worksheet to Hallmark Mortgage electronically by clicking "Submit" below, or I may submit this worksheet by fax or mail. If I choose to submit this worksheet electronically, I knowledge that, regardless of the fact that my browser may have security features available, Hallmark Mortgage is unable to ensure that the data cannot be intercepted by third parties. I agree that Hallmark Mortgage will not be held liable should such interception occur.       Borrower Signature (enter name if online) Co-Borrower Signature (enter name if online)             Borrower Signature Date Co-Borrower Signature Date

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