Name: _____________________________  Co-Borrower: _________________________________

Social Security Number: ___________________________  Co-SS#: _________________________

Date of Birth: _____________________________   Co-DOB: ______________________________

Street Address: ____________________________________________________________________

City: ______________________________   Phone Number: ________________________________

Desired Loan Amount: $ _______________________  Type of Loan  __ Purchase  __ Refinance

Are you putting money down?  Yes/No     If yes, what is the amount:  _____________________

Do you currently own a home?  Yes/No    If yes, what is the balance owed: $________________

Street Address of property in ownership: ____________________________________________

City: ____________________________  Zip Code: _______________

Purpose for refinance (rate-term, cash-out, etc): _______________________________________

________________________________________________________________________________

 EMPLOYMENT INFORMATION

Employer: ________________________________  Self-employed?  _______  How Long: _______

Position:  ________________________________     Annual / Monthly gross Income: ____________

If less than 2 years, prior employment / line of work: _____________________________________

Co-borrowers employer: ____________________________________________________________

If less than 2 years, prior employment: ________________________________________________

Position:  ________________________________     Annual / Monthly gross Income: ____________

Any other income (commission, bonus, social security, pensions, alimony, etc.): ______________

__________________________________________________________________________________

Clarion Mortgage Company

Attn:  Susan Hwe Johnson   Fax:  650-475-7127    Phone: 650-271-5741