CLIENT PROFILE
First Name Middle Name Last Name    
Current Address City State Zipcode
Number of years at current address Former Address (If less than 2 year at current Address )
Phone(Home) Phone(Other)   Email Address
Date of Birth SSN      
Marital Status Number of dependants Ages  
EMPLOYMENT INFORMATION
Employer Name Position/Title    
Employer Address City State Zip Code
Work Phone Date Hired    
Former Employer(If less than 2 year) Position/Title    
Former Employer Address City State Zip Code
Former Employer Phone Dates Emplyed From (mo/yr)   To(mo/yr)
  Yes No N/A  
Can you verify last 30 days of income with current paystubs?  
Can you provide w-2 Statements for the past 2 year ?  
Can you provide Bank Statements for the post 2 months ?  
Do you currently have a mortgage ?
  
If yes, how many mortgaged properties do you currently own ?  
Do you have any late mortgate payments in the past 2 years ?  
 
I herby authorize Koala Equity Group to order a consumer credit report and verify other credit information. It is understood that a copy of this credit application will also serve as authorization. I certify and acknowledge that the information provided id, to the best of my knowledge, accurate and that any false information provided may result in disqualification of approval.
Signature Print Name Date    
INCOME
Average Monthly Income (Employment) Average Monthly Income (Other) $
ASSETS
Please list all bank account and blance to be verified
Name of bank Estimated Average Balance For Past 2 Months $
Name of bank Estimated Average Balance For Past 2 Months $
Please list all other sources of funds to be verified. (stocks, bonds, 40 lk, IRA...)
Source of funds Estimated Average Balance For Past 2 Months $
Source of funds Estimated Average Balance For Past 2 Months $
Source of funds Estimated Average Balance For Past 2 Months $
MORTGAGE
Please provide the following information on your PRIMARY RESIDENCE
Name of Lender Current Balance Estimated Value
Principal & Interest Payment Taxes Insurance
           
Please provide the following information on any SECOND HOMES or INVESTMENT PROPERTIES
1)
Name of Lender Current Balance Estimated Value
Principal & Interest Payment(Payment Breakdown) Taxes Insurance
monthly Rental Income(If Applicable)        
2)          
Name of Lender Current Balance Estimated Value
Principal & Interest Payment(Payment Breakdown) Taxes Insurance
monthly Rental Income(If Applicable)        
3)          
Name of Lender Current Balance Estimated Value
Principal & Interest Payment(Payment Breakdown) Taxes Insurance
monthly Rental Income(If Applicable)