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Loan Officer
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Anthony Asquith
Beverlee Peters
Gabriela Dela Cruz
Hailee Dale
Jamie Chambers
Jared Penn
Jason Mevorah
Joaquin Ceballos
Mike Rasmussen
Myra Talley
Myriam Gamboa
Nikita Burdick
Ryan Dearkland
Shelly Panzarella
Stan Atanasov
Contact Information
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Afghanistan
Åland Islands
Albania
Algeria
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Antarctica
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Cameroon
Canada
Cape Verde
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Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
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Congo, Republic of the
Cook Islands
Costa Rica
Côte d'Ivoire
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Nigeria
Niue
Norfolk Island
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Panama
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Paraguay
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Poland
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Russia
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Saint Helena
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Samoa
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Turks and Caicos Islands
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Ukraine
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Uruguay
US Minor Outlying Islands
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Venezuela
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Virgin Islands, British
Virgin Islands, U.S.
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Referral Information
Referred By
Comments
Property Information
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Primary Residence
Second Home/Vacation Home
Investment Property
Number of Units At Property
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Property Address
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Same as Borrower Current Address
Street Address
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City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
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Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
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Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
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Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
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El Salvador
Equatorial Guinea
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Ethiopia
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Faroe Islands
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Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
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India
Indonesia
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Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
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Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
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Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russia
Rwanda
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
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Tokelau
Tonga
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Turkey
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Tuvalu
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Uruguay
US Minor Outlying Islands
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Loan Information
Loan Type
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Fixed
ARM
Loan Purpose
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Select One
Purchase
Refinance
Purchase Price
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Term (in years)
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Desired Rate
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Down Payment
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(Enter % or Dollar Amount)
Borrower Information
Name
First
Middle
Last
Marital Status
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Married
Unmarried (single, divorced, widowed)
Separated
Social Security #
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Date of Birth
*
Date Format: MM slash DD slash YYYY
Co-Borrower Information
Name
First
Middle
Last
Marital Status
Married
Unmarried (single, divorced, widowed)
Separated
Social Security #
Date of Birth
Date Format: MM slash DD slash YYYY
Phone
Borrower Address
Address
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Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russia
Rwanda
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
US Minor Outlying Islands
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Years at Address
*
Do You Own or Rent?
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Select One
Rent
Own
Mailing Address
*
Same as Current Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russia
Rwanda
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
US Minor Outlying Islands
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Co-Borrower Address
Present Address
Same as Borrower Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russia
Rwanda
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
US Minor Outlying Islands
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Years at Address
Do You Own or Rent?
Select One
Rent
Own
Mailing Address
Same as Borrower Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russia
Rwanda
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
US Minor Outlying Islands
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Borrower Employment
Current Employer
*
Self Employed?
*
Self Employed?
Years
*
Months
*
Secondary/Previous Employers
If employed in current position for less than 2 years, or if currently employed in more than one position, complete secondary or previous employment.
Employer
Self Employed?
Self Employed?
Start
Date Format: MM slash DD slash YYYY
End
Date Format: MM slash DD slash YYYY
Employer
Self Employed?
Self Employed?
Start
Date Format: MM slash DD slash YYYY
End
Date Format: MM slash DD slash YYYY
Co-Borrower Employment
Current Employer
Self Employed?
Self Employed?
Years
Months
Secondary/Previous Employers
If employed in current position for less than 2 years, or if currently employed in more than one position, complete secondary or previous employment.
Employer
Self Employed?
Self Employed?
Start
Date Format: MM slash DD slash YYYY
End
Date Format: MM slash DD slash YYYY
Employer
Self Employed?
Self Employed?
Start
Date Format: MM slash DD slash YYYY
End
Date Format: MM slash DD slash YYYY
MONTHLY Income Information
*Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.
Borrower: Gross Income Breakdown
Base Income:
*
Overtime:
Bonuses:
Commissions:
Dividends/Interest
Net Rental Income:
Co-Borrower: Gross Income Breakdown
Base Income:
Overtime:
Bonuses:
Commissions:
Dividends/Interest
Net Rental Income:
Additional Income Information
Notice: Alimony, child support, or separate maintenance income need not be revealed if the Borrower(B) or Co-Borrower(C) does not choose to have it considered for repaying this loan.
B/C
Select One
Borrower
Co-Borrower
Description of Other Income
If Other Income - Please Specify
Alimony/Child Support Income
Automobile/Exp Acct Income
Foster Care
Note Receivable/Installment
Pension/Retirement Income
Social Security/Disability Inc
Trust Income
Unemployment/Welfare Income
VA Benefits (non-education)
Military Base Pay
Military Rations Allowance
Military Flight Pay
Military Hazard Pay
Military Clothse Allowance
Military Quarters Allowance
Military Prop Pay
Military Overseas Pay
Military Combat Pay
Military Va Housing Allowance
Other Income
Monthly Amount
B/C
Select One
Borrower
Co-Borrower
Description of Other Income
If Other Income - Please Specify
Alimony/Child Support Income
Automobile/Exp Acct Income
Foster Care
Note Receivable/Installment
Pension/Retirement Income
Social Security/Disability Inc
Trust Income
Unemployment/Welfare Income
VA Benefits (non-education)
Military Base Pay
Military Rations Allowance
Military Flight Pay
Military Hazard Pay
Military Clothse Allowance
Military Quarters Allowance
Military Prop Pay
Military Overseas Pay
Military Combat Pay
Military Va Housing Allowance
Other Income
Monthly Amount
B/C
Select One
Borrower
Co-Borrower
Description of Other Income
If Other Income - Please Specify
Alimony/Child Support Income
Automobile/Exp Acct Income
Foster Care
Note Receivable/Installment
Pension/Retirement Income
Social Security/Disability Inc
Trust Income
Unemployment/Welfare Income
VA Benefits (non-education)
Military Base Pay
Military Rations Allowance
Military Flight Pay
Military Hazard Pay
Military Clothse Allowance
Military Quarters Allowance
Military Prop Pay
Military Overseas Pay
Military Combat Pay
Military Va Housing Allowance
Other Income
Monthly Amount
Asset Information
Cash Deposit Held by Escrow Co.
Checking Account
*
Savings Account
*
Money Market
Mutual Funds
Trust Funds
Stocks & Bonds
Vested Interest in Retirement
Funds
Net Worth of Business(es) Owned
Other Assets
Monthly Debt Information
Credit Cards:
Monthly Payment
Unpaid Balance
Automobile Loans:
Monthly Payment
Unpaid Balance
Personal Loans:
Monthly Payment
Unpaid Balance
Existing Mortgages:
Monthly Payment
Unpaid Balance
Other Debts:
Monthly Payment
Unpaid Balance
Other Liabilities
Monthly Alimony / Child Support / Separate Maintenance Payments
Monthly Job Related Expenses (child care, union dues, etc...)
Present Monthly Housing Expense Information
Rent:
OR
First Mortgage (Principal & Interest):
Second Mortgage (Principal & Interest):
Hazard Insurance:
Real Estate Taxes:
Mortgage Insurance:
Homeowners Assn. Dues:
Other Expenses:
Properties
If you currently own properties, please describe them below.
Property 1
Property Type:
Select One
Single Family Residence
Condominium
Townhouse
Cooperative
Two-to-Four-Unit Residence
Multifamily (4+ Units)
Mobile Home
Mixed Use - Residential
Commercial - Non Res.
Commercial - Residential
Farm
Land and Lots
Other
Property Status
Select One
Rental
Sold
Pending Sale
Own
Market Value:
Current Balance:
Monthly Payments:
Monthly Rental Income:
Monthly Insurance, Maintenance, Taxes & Misc. :
Property 2
Property Type:
Select One
Single Family Residence
Condominium
Townhouse
Cooperative
Two-to-Four-Unit Residence
Multifamily (4+ Units)
Mobile Home
Mixed Use - Residential
Commercial - Non Res.
Commercial - Residential
Farm
Land and Lots
Other
Property Status
Select One
Rental
Sold
Pending Sale
Own
Market Value:
Current Balance:
Monthly Payments:
Monthly Rental Income:
Monthly Insurance, Maintenance, Taxes & Misc. :
Property 3
Property Type:
Select One
Single Family Residence
Condominium
Townhouse
Cooperative
Two-to-Four-Unit Residence
Multifamily (4+ Units)
Mobile Home
Mixed Use - Residential
Commercial - Non Res.
Commercial - Residential
Farm
Land and Lots
Other
Property Status
Select One
Rental
Sold
Pending Sale
Own
Market Value:
Current Balance:
Monthly Payments:
Monthly Rental Income:
Monthly Insurance, Maintenance, Taxes & Misc. :
Property 4
Property Type:
Select One
Single Family Residence
Condominium
Townhouse
Cooperative
Two-to-Four-Unit Residence
Multifamily (4+ Units)
Mobile Home
Mixed Use - Residential
Commercial - Non Res.
Commercial - Residential
Farm
Land and Lots
Other
Property Status
Select One
Rental
Sold
Pending Sale
Own
Market Value:
Current Balance:
Monthly Payments:
Monthly Rental Income:
Monthly Insurance, Maintenance, Taxes & Misc. :
Declarations
Federal laws and regulations require that we ask you, and you provide answers to the following questions.
a. Are there any outstanding judgements against you?
Borrower
*
Yes
No
Co-Borrower
Yes
No
b. Have you been declared bankrupt within the past 7 years?
Borrower
*
Yes
No
Co-Borrower
Yes
No
c. Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?
Borrower
*
Yes
No
Co-Borrower
Yes
No
d. Are you a party to a lawsuit?
Borrower
*
Yes
No
Co-Borrower
Yes
No
e. Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment? (This would include such loans as home mortgage loans, SBA loans, home improvement loans, educational loans, manufactured (mobile) home loans, any mortgage, financial obligation, bond, or loan guarantee. If "Yes," provide details, including date, name and address of Lender, FHA or VA case number, if any, and reasons for the action)
Borrower
*
Yes
No
Co-Borrower
Yes
No
f. Are you presently delinquent or in default on any federal debt or any other loan, mortgage, financial obligation bond, or loan guarantee? If "Yes," give details as described in the preceding question.
Borrower
*
Yes
No
Co-Borrower
Yes
No
g. Are you obligated to pay alimony, child support, or separate maintenance?
Borrower
*
Yes
No
Co-Borrower
Yes
No
h. Is, or will, any part of the down payment be borrowed?
Borrower
*
Yes
No
Co-Borrower
Yes
No
i. Are you a co-maker or endorser on a note?
Borrower
*
Yes
No
Co-Borrower
Yes
No
j. Are you a U. S. citizen?
Borrower
*
Yes
No
Co-Borrower
Yes
No
k. Are you a permanent resident alien?
Borrower
*
Yes
No
Co-Borrower
Yes
No
l. Do you intend to occupy the property as your primary residence?
Borrower
*
Yes
No
Co-Borrower
Yes
No
m. Have you had an ownership interest in a property in the last three years?
Borrower
*
Yes
No
Co-Borrower
Yes
No
If yes, complete the questions below.
Borrower
Select One
Primary Resdience
Secondary Residence
Investment Property
Co-Borrower
Select One
Primary Resdience
Secondary Residence
Investment Property
(2) How is the title held on your previous property?
Borrower
Select One
Primary Resdience
Secondary Residence
Investment Property
Co-Borrower
Select One
Primary Resdience
Secondary Residence
Investment Property
Acknowledgement & Agreement
Each of the undersigned specifically represents to Lender and to Lenders actual or potential agents, brokers, processors, attorneys, insurers, servicers, successors and assigns and agrees and acknowledges that: (1) the information provided in this application is true and correct as of the date set forth opposite my signature and that any intentional or negligent misrepresentation of this information contained in this application may result in civil liability, including monetary damages, to any person who may suffer any loss due to reliance upon any misrepresentation that I have made on this application, and/or in criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Sec. 1001, et seq.; (2) the loan requested pursuant to this application (the "Loan") will be secured by a mortgage or deed of trust on the property described in this application; (3) the property will not be used for any illegal or prohibited purpose or use; (4) all statements made in this application are made for the purpose of obtaining a residential mortgage loan; (5) the property will be occupied as indicated in this application; (6) the Lender, its servicers, successors or assigns may retain the original and/or an electronic record of this application, whether or not the Loan is approved; (7) the Lender and its agents, brokers, insurers, servicers, successors, and assigns may continuously rely on the information contained in the application, and I am obligated to amend and/or supplement the information provided in this application if any of the material facts that I have represented herein should change prior to closing of the Loan; (8) in the event that my payments on the Loan become delinquent, the Lender, its servicers, successors or assigns may, in addition to any other rights and remedies that it may have relating to such delinquency, report my name and account information to one or more consumer reporting agencies; (9) ownership of the Loan and/or administration of the Loan account may be transferred with such notice as may be required by law; (10) neither Lender nor its agents, brokers, insurers, servicers, successors or assigns has made any representation or warranty, express or implied, to me regarding the property or the condition or value of the property; and (11) my transmission of this application as an "electronic record" containing my "electronic signature," as those terms are defined in applicable federal and/or state laws (excluding audio and video recordings), or my facsimile transmission of this application containing a facsimile of my signature, shall be as effective, enforceable and valid as if a paper version of this application were delivered containing my original written signature. Acknowledgement. Each of the undersigned hereby acknowledges that any owner of the Loan, its servicers, successors and assigns, may verify or reverify any information contained in this application or obtain any information or data relating to the Loan, for any legitimate business purpose through any source, including a source named in this application or a consumer reporting agency.
Government Monitoring
The following information is requested by the Federal Government for certain types of loans related to a dwelling in order to monitor the lenders 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 not discriminate either on the basis of this information, or on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, this lender is required to note the information on the basis of visual observation and surname if you have made this application in person. If you do not wish to furnish the information, please check the box below. (Lender must review the above material to assure that the disclosures satisfy all requirements to which the lender is subject under applicable state law for the particular type of loan applied for.)
Personal Information
I do not wish to furnish this information
Borrower
Co-Borrower
Ethnicity:
Borrower
Select One
Hispanic or Latino
Not Hispanic or Latino
Co-Borrower
Select One
Hispanic or Latino
Not Hispanic or Latino
Race:
Borrower
Select One
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Asian
White
Black or African American
Co-Borrower
Select One
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Asian
White
Black or African American
Sex:
Borrower
Select One
Female
Male
Co-Borrower
Select One
Female
Male