BORROWER & CO-BORROWER INFORMATION
  Borrower Co-Borrower
Name
(Include Jr. or Sr. if applicable)
Social Security Number
Email
Home Phone
(incl. area code) (incl. area code)
D.O.B.
(mm/dd/yyyy) (mm/dd/yyyy)
Years of School
Status
Married (includes registered domestic partners)
Unmarried (includes single, divorced, widowed)
Separated
Married (includes registered domestic partners)
Unmarried (includes single, divorced, widowed)
Separated
Dependents
(not listed by Co-Borrower) / Ages (not listed by Co-Borrower) / Ages
Present Address
City/State/Zip
/ / / /
Do You
Own Rent years Own Rent years
     
Mailing Address
(if different from above)
City/State/Zip
/ / / /
     
   If residing at present address for less than two years, complete the following
Address
City/State/Zip
/ / / /

 EMPLOYMENT INFORMATION
  Borrower Co-Borrower
Employer Name
/ Self Employed / Self Employed
Employer Address
City/State/Zip
/ / / /
# Years on this job
# Years employed in this line of work profession
Position/Title/Type of Business
Business Phone
     
   If employed in current position for less than two years or if currently employed in more than one position, complete the following
Employer Name
/ Self Employed / Self Employed
Employer Address
City/State/Zip
/ / / /
# Years on this job
# Years employed in this line of work profession
Position/Title/Type of Business
Business Phone


 MONTHLY INCOME & COMBINED HOUSING EXPENSE INFORMATION
Gross Monthly Income Borrower Co-Borrower Total Combined Monthly Housing Expense Present Proposed
Salary $ $ $ Rent $ $
Hourly Rate $ $ $ First Mortgage (P&I) $ $
Average Hours Weekly
Other Financing (P&I) $ $
Other
Alimony, child support, or seperate maintenance income need not be revealed if the Borrower (B) or
Co-Borrowe (C) does not choose to have it considered for repaying this loan.
Hazard Insurance $ $
$ $ $ Real Estate Taxes $ $
$ $ $ Mortgage Insurance $ $
$ $ $ Homeowners Assn. Dues $ $
$ $ $ Other $ $
TOTAL $ $ $ TOTAL $ $
* Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements

 CHECKING & SAVINGS ACCOUNTS
Bank, S&L, Credit Union Name Address City/State/Zip Acct. # $
/ /
/ /
/ /

 REAL ESTATE OWNED
Property Address
(enter S if sold, PS if pending sale or R if rental being held for income)
Type of Property
Present Market Value
Amount of Mortgage & Liens
Gross Rental Income
Mortgage Payments
Insurance, Maintenance, Taxes & Misc.
Net Rental Income
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
 
TOTAL
$
$
$
$
$
$
List any additional names under which credit has previously been received and indicate appropriate creditor name(s) and account numbers(s):

Altername Name Creditor Name Account Number

 DECLARATIONS
If you answer "Yes" to any questions a through I, please
Borrower
 
Co-Borrower
Yes
No
Yes
No
a. Are there any outstanding judgements against you?
b. Have you declared bankrupt within the past 7 years?
c. Have you had property foreclosed upon or given title or deed in lieu thereof in the past 7 years?
d. Are you a party to a lawsuit?
e. Have you directly or indirectly been obligated on any loan which resulted in foreclosur, transfer of title in lieu of foreclosure, or judgement?
(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.)
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 previous question.)
g. Are you obligated to pay alimony, child support, or seperate maintenance?
h. Is any part of the down payment borrowed?
i. Are you a co-maker or endorser of a note?

       
j. Are you a U.S. citizen?
k. Are you a permanent alien?
l. Do you intend to occupy the property as your primary residence?
(If "Yes", complete question mm below.)
m. Have you had an ownership interest in a property in the last three years?    
          (1) What type of property did you own-principal residence (PR), second home (SH) or investment property (IP)?
          (2) How did you hold title to the home: solely by yourself (S), jointly with your spouse (SP) or jointly with another person (O)?

 INFORMATION FOR GOVERNMENT MONITORING PURPOSES
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. The law provides that a Lender may not discriminate either on the basis of this information, or on whether to choose to furnish it. If you furnish this 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, the 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.)
  Borrower Co-Borrower
I do not wish to provide this information Will Not Provide Will Not Provide

Ethnicity Hispanic or Latino
Not Hispanic or Latino
Hispanic or Latino
Not Hispanic or Latino

Race American Indian
Asain
Black or African American
Native Hawaiian or Other Pacific Islander
White
American Indian
Asain
Black or African American
Native Hawaiian or Other Pacific Islander
White

Sex Male Female Male Female