- Loan Information -

Loan Purpose:

Property Type:

Loan Type:

Interest Rate:

New Purchase Refinance

Single Family Home

Loan Amount

Property Value / Purchase Price:

Down Payment:

Property Address:

City, State & Zip Code:

- Borrower Information -

First Name:

M.I.:

Last Name:

Social Security #:

Marital Status:

Home Phone #:

Email Address:

Age:

Years Of School:

- Co-Borrower Information -

First Name:

M.I.:

Last Name:

Social Security #:

Marital Status:

Home Phone #:

Email Address:

Age:

Years Of School:

- Current Address Information -

Borrower Current Address Information

Current Address:

City, State & Zip Code:

Years at Address:

Months at Address:

Own, Rent or Live/Rent Free:

Own Rent Live Rent Free

Co-Borrower Current Address Information

Current Address:

City, State & Zip Code:

Years at Address:

Months at Address:

Own, Rent or Live/Rent Free:

Own Rent Live Rent Free

- Employment Information -

Borrower - Current Employer

Current Employer:

Employer’s Address:

City, State & Zip Code:

Position or Title:

 Work Phone #:

Time With Employer (Year & Months)

Years in This Line             of Work:

Monthly Income:

Are You Self Employed:

No Yes

Borrower - Previous/Secondary Employment

Employer’s Name:

Employer’s Address:

City, State & Zip Code:

Position or Title:

Work Phone #:

Time With Employer:

Years in This Line             of Work

Monthly Income:

Were You Self-Employed:

No Yes

BORROWER Please provide your Current Income information:
1) Enter your MONTHLY income before taxes from your current employer and the monthly average amounts for any overtime, bonuses, or commissions you received in the previous 12 months.
2) If self-employed, you may be required to provide additional documentation such as tax returns and financial statements.
3) Please describe other income if reported in the box provided.
4) Alimony, child support, or seperate maintenance income need not be revealed if you choose not to have it considered for repayment.

Monthly Base Income BEFORE Taxes:

Average monthly Overtime BEFORE taxes:

Average monthly Bonuses BEFORE taxes:

Average monthly Commissions BEFORE taxes:

Average monthly Dividend/interest BEFORE taxes:

Other montly income:

Description of Other monthly income:

Co-Borrower - Current Employment

Current Employer:

Employer’s Address:

City, State & Zip Code:

Position or Title:

Work Phone #:

Time With Employer
(Year & Months)

Years in This Line
of Work:

Monthly Income:

Are You Self-Employed:

No Yes

Co-Borrower  - Previous/Secondary Employment

Employer’s Name:

Employer’s Address

City, State & Zip Code:

Position or Title:

Work Phone #:

Time With Employer:

Years in This Line
of Work:

Monthly Income:

Were You Self Employed:

No Yes

CO-BORROWER Please provide your Current Income information:
1) Enter your MONTHLY income before taxes from your current employer and the monthly average amounts for any overtime, bonuses, or commissions you received in the previous 12 months.
2) If self-employed, you may be required to provide additional documentation such as tax returns and financial statements.
3) Please describe other income if reported in the box provided.
4) Alimony, child support, or seperate maintenance income need not be revealed if you choose not to have it considered for repayment.

Monthly Base Income BEFORE Taxes:

Average monthly Overtime BEFORE Taxes:

Average monthly Bonuses BEFORE Taxes:

Average monthly Commissions BEFORE Taxes:

Average monthly dividend/interest BEFORE Taxes:

Other monthly income:

Description of Other monthly income:

Federal laws and regulations require that we ask you, and you provide answers to the following questions.
 

Borrower

Co-Borrower

1) Are there any judgements against you?

No Yes

No Yes

2) Have you declared bankruptcy in the past 7 years?

No Yes

No Yes

3) Have you had a property foreclosed upon or given a deed in lieu of foreclosures in the past 7 years?

No Yes

No Yes

4) Are you party to a lawsuit?

No Yes

No Yes

5) Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure of judgement?
(This would include such loans as home mortgages, SBA Loans, home improvement loans, educational loans, manufactured (mobile) home loans, any mortgages, financial obligations, bond, or loan guarantees.)

No Yes

No Yes

6) Are you presently delinquent on any Federal debt or any other loan?

No Yes

No Yes

7) Are you obligated to pay alimony, child support, or seperate maintenance?

No Yes

No Yes

8) Is or will any part of the down payment be borrowed?

No Yes

No Yes

9) Are you a co-worker or endorser on any other person’s obligation(s)?

No Yes

No Yes

10) Do you intend to occupy this subject property as your primary residence?

Yes No

Yes No

11) If yes, have you had an ownership interest in a property in the past 3 years?

Yes No

Yes No

12) If Yes, what type of property did you own?

13) How is the title held on your previous property?

14) What is your citizenship?

Government Monitoring: The following infomation is requested by the Federal Government for certain types of loans relating 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. The law provides that a lender may neither discriminate on the basis of this information, nor on whether you choose to furnish it. However, if you choose not to furnish it, under Federal Regulation, this Lender is required to note race and sex based on visual observation or surname.

Do you wish to provide information regarding your race, national origin, or sex?

Yes No

Yes No

What is your sex?

Male

Female Male

What is your national origin?

American

American

If Other, Please Specify

Borrower Assets

Bank Name:

Account Number:

Cash or Market Value:

Bank 1

Bank 2

Bank 3

Bank 4

Bank 5

Stocks & Bonds

Company Name:

Number:

Cash or Market Value:

Company 1

Company 2

Comapny 3

Company 4

Company 5

Other Assets

Type of Asset

Cash or Market Value:

Vested interest in Retirement Fund

Net worth of business(es) owned:

Automobile 1.

Automobile 2.

Automobile 3.

Other 1.

Other 2.

Other 3.

Co-Borrower Assets

Bank Name

Account Number

Cash or Market Value

Bank 1

Bank 2

Bank 3

Bank 4

Bank 5

Stocks & Bonds

Company Name

Number

Cash or Market Value

Company 1

Company 2

Company 3

Company 4

Company 5

Other Assets

Type of Asset

Cash or Market Value

Vested interest in Retirement Fund:

Net Worth of business(es) owned:

Automobile 1.

Automobile 2.

Automobile 3.

Other 1.

Other 2.

Other 3.

Liability Information

Please provide your liability information:

* Enter the Creditor’s Name

* The liability account number

* Enter the Total unpaid balance of the credit

* Enter the monthly payment of the credit

Borrower Liabilities

Company Name

Account Number

Unpaid Balance

Monthly Payment

Debt 1

Debt 2

Debt 3

Debt 4

Debt 5

Debt 6

Debt 7

Debt 8

Other Liabilities                      Monthly Payments      

Alimony

Child Support

Separate Maintenance

Job Related Expenses

Co-Borrower Liabilities

Debt 1

Debt 2

Debt 3

Debt 4

Debt 5

Debt 6

Debt 7

Debt 8

Other Liabilities                      Monthly Payments    

Alimony

Child Support

Separate Maintenance

Job Related Expenses

Borrower Current Mortgage or Rent Information

Rent

- OR -

Current Housing Expenses

Proposed Mortgage Loan

1st Mortgage (P&I)

1st Mortgage (P&I)

Other Financing (P&I)

Other Financing (P&I)

Hazard Insurance

Hazard Insurance

Real Estate Taxes

Real Estate Taxes

Mortgage Insurance

Mortgage Insurance

Homeowner Dues

Homeowner Dues

Other Expenses

Other Expenses

Co-Borrower Current Mortgage or Rent Information

Rent

- OR -

Current Housing Expenses

Proposed Mortgage Loan

1st Mortgage (P&I)

1st Mortgage (P&I)

Other Financing (P&I)

Other Financing (P&I)

Hazard Insurance

Hazard Insurance

Real Estate Taxes

Real Estate Taxes

Mortgage Insurance

Mortgage Insurance

Homeowner Dues

Homeowner Dues

Other Expenses

Other Expenses

Current Real Estate Information

Please provide your current Real Estate Information on Real Estate Owned

Property #1

Street

Market Value

City, State & Zip

Mtg Payment

Property Type

Mtg. Liens

Property #2

Street

Market Value

City, State & Zip

Mtg. Payment

Property Type

Mtg. Liens

Property #3

Street

Market Value

City, State & Zip

Mtg. Payment

Property Type

Mtg. Liens

Use This Section to Add any Comments You Wish to Send

Acknowledgement & Agreement

The undersigned specifically acknowledges and agrees that:
(1) The loan requested by this application will be secured by a first mortgage or deed of trust on the property. Described herein:
(2) the property will not be used for any illegal or prohibited purpose or use;
(3) all statements made in this application are made for the purpose of obtaining the loan indicated herein;
(4) occupancy of the property will be as indicated above;
(5) verification or re-verification of any information contained in the application may be made at any time by the lender, its agents, successors and assigns, either directly or thru a credit reporting agent, from any source named in this application, and the original copy of this application will be retained by the lender, even if the loan is not approved;
(6) the lender, its agents, successors and assigns will rely on the information contained in the application ad I’ve have a continuing obligation to amend and/or supplement the information provided in this application if any of the material facts which I/we have represented herein should change prior to closing;
(7) in the event my/our payments on the loan indicated in tis application become delinquent, the lender, its agents, successors and assigns, may, in addition to all their other rights and remedies, report my/our names and account information to a credit reporting agency;
(8) ownership of the loan may be transferred to successor or assign of the lender without notice to me and/or the administration of the loan account may be transferred to an agent, successor or assign of the lender with prior notice to me;
(9) the lender, its agents, successor and assigns make no representations or warranties, expressed or implied, to the borrowers regarding he property, the condition of the property, or the value of the property.

I/we have the right to a copy of the appraisal report used in connection with this application for credit. To obtain a copy, I/We must send a lender a written request at the mailing address Lender has provided. Lender must hear from me/us no later than 90 days after Lender notifies me/us about the action taken on the application, or I/We withdraw this application.

I/We certify that the information provided in this application is true and correct as of the date set forth opposite my/our signature(s) on this application and acknowledge my/our understanding that my intentional or negligent misrepresentations of the information contained in this application may result in civil liability and/or criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of title 18, United States Code, Section 1001, et. seq. and liability for monetary damages to the lender, its agents, successors and assigns, insurers and any other person who may suffer any loss due to the reliance upon any misrepresentations which I/We have made on this application.

Borrower Acknowledgement

Co-Borrower Acknowledgement