GLOBAL FUNDING CORPORATION

General Information
First Name
Middle Name
Last Name
Email
Daytime Phone	() -
Evening Phone	() -
Referred By

Marital Status
Resident Status
Date of Birth	/ /
Dependents	Number Ages(seperated by commas)
Present Address
Street
City
State	Zip
Ownership	Years
Previous Address	(Needed if residing at present address for less than 2 years)
Street
City
State	Zip

The following information is requested by the federal government for certain types of loans related to a dwelling in order to monitor the lender's compliance with equal credit opportunity, fair housing, and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. You may select one or more designations for "Race." The law provides that a lender may not discriminate on the basis of this information, or on whether you choose to furnish it. However, if you choose not to furnish the information and you have made this application in person, under federal regulations the lender is required to note ethnicity, race, and sex on the basis of visual observation or surname.

I do not wish to furnish this information
Ethnicity
Race	American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White
Sex(M/F)
Monthly Income
Base
Bonus
Commission
Other
Assets
Checking
Savings
401k
Other
About the Property
Property Usage
Purpose of Loan
Purpose of Refinance
Loan Amount
Property Value
Number of Units
Year Built
Address of Subject Property
Street
City
State	Zip

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