1. Type of Mortgage and Terms of Loan
Mortgage Applied for:
Loan Amount:
Interest Rate: %
No. of Months:
Amortization Type:
2. Property Information and Purpose of Loan
Subject Property Address:
City:
State:
ZIP Code:
Number of Units:
Purpose of Loan:
Property Will Be:
Purchase Price or Estimated Value:
Source of Down Payment, Settlement Charges, and/or Subordinate Financing:
Estate Will Be Held in:
Complete the items below if this is a construction, construction-permanent, or refinance loan:
3. Borrower Information
First Name: *
Middle Initial:
Last Name: *
Generation Suffix (if applicable):
(for example, Jr., Sr., or II)
 You may check my credit report at this time
Social Security Number: - -
Evening Phone: ( )  - *
Marital Status:
Number of Dependents:
(Count shared dependents once)
Email Address: *
Present Address
Street:
City:
State:
ZIP Code:
Rent or Own?
How Long at Address:  years    months
Complete the following if at present address less than two years:
Former Address
Street:
City:
State:
ZIP Code:
Rent or Own?
How Long at Address:  years   months
3a. Co-borrower Information
First Name:
Middle Initial:
Last Name:
Generation Suffix (if applicable):
(for example, Jr., Sr., or II)
 You may check my credit report at this time
Social Security Number: - -
Evening Phone: ( )  -
Marital Status:
Number of Dependents:
(Count shared dependents once)
Present Address ( Same as Borrower )
Street:
City:
State:
ZIP Code:
Rent or Own?
How Long at Address:  years   months
Complete the following if at present address less than two years.
Former Address ( Same as Borrower )
Street:
City:
State:
ZIP Code:
Rent or Own?
How Long at Address:  years   months
4. Employment Information
Current Employer
Borrower Co-borrower
Employer Name:
Self-employed: 
Time on Job:
  years    months
Employer Name:
Self-employed: 
Time on Job:
  years    months
Previous Employment
If employed in current position less than two years or if currently employed in more than one position, complete the following:
Borrower Co-borrower
Secondary Current
Employer: 
Employer Name:
Self-employed: 
Time on Job:
  years    months
Start Date: 
Secondary Current
Employer: 
Employer Name:
Self-employed: 
Time on Job:
  years    months
Start Date: 
Borrower Co-borrower
Secondary Current
Employer: 
Employer Name:
Self-employed: 
Time on Job:
  years    months
Start Date: 
Secondary Current
Employer: 
Employer Name:
Self-employed: 
Time on Job:
  years    months
Start Date: 
5. Monthly Income and Combined Housing Expense Information
Gross Monthly Income Borrower Co-borrower
Base Empl. Income:
Overtime:
Bonuses:
Commissions:
Dividends/Interest:

Describe Other Income: Notice: Alimony, child support, or separate maintenance need not be revealed if you do not choose to have it considered for repayment of this loan.
  Owner Description Monthly Amount
#1
#2
#3

Combined Monthly Housing Expense Where You Live Now Proposed Loan
Rent:  
First Mortgage (P&I):  
Other Financing (P&I):  
Hazard Insurance:  
Real Estate Taxes:
Mortgage Insurance:  
Homeowner Assn. Dues:
Other:  
6. Assets
This statement and any applicable supporting schedules may be completed jointly by both married and unmarried co-borrowers if their assets and liabilities are sufficiently joined so that the statement can be meaningfully and fairly presented on a combined basis; otherwise, separate statements and schedules are required. If the co-borrower section was completed about a spouse, this statement and supporting schedules must be completed about the spouse also.
List assets, including checking and savings accounts below.
Account Owner:
Asset Type:
Description:
Cash or Market Value:
Account Owner:
Asset Type:
Description:
Cash or Market Value:
Account Owner:
Asset Type:
Description:
Cash or Market Value:
Account Owner:
Asset Type:
All Other Assets:
Cash or Market Value:
Schedule of Real Estate Owned 
Current/Subject:
Property Disposition:
Property Street:
Property City:
Property State:
Property ZIP Code:
Present Market Value:
Gross Rental Income:
Insurance, Maint., Misc.:
Current/Subject:
Property Disposition:
Property Street:
Property City:
Property State:
Property ZIP Code:
Present Market Value:
Gross Rental Income:
Insurance, Maint., Misc.:
Enter All Remaining Properties Combined
Present Market Value:
Gross Rental Income:
Insurance, Maint., Misc.:
7. Declarations
Items Borrower Co- borrower
a. Are there any outstanding judgments against you? Yes
No		 Yes
No
b. Have you been declared bankrupt within the last seven years? Yes
No		 Yes
No
c. Have you had property foreclosed upon or given title or deed in lieu thereof in the last seven years? Yes
No		 Yes
No
d. Are you a party to a lawsuit? Yes
No		 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.) Yes
No		 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? Yes
No		 Yes
No
g. Are you obligated to pay alimony, child support, or separate maintenance? Yes
No		 Yes
No
h. Is any part of the down payment borrowed? Yes
No		 Yes
No
i. Are you a co-maker or endorser on a note? Yes
No		 Yes
No
j. Are you a U.S. citizen? Yes
No		 Yes
No
k. Are you a permanent resident alien? Yes
No		 Yes
No
l. Do you intend to occupy the property as your primary residence? Yes
No		 Yes
No
m. Have you had an ownership interest in a property in the last three years? (If you answered Yes, complete questions 1 and 2 below.) Yes
No		 Yes
No
1. What type of property did you own?
Borrower Co-borrower
2. How did you hold title to the home?
Borrower Co-borrower
If you answered yes to any questions A through I above, explain in the box below.
8. Information for Government Monitoring Purposes
The following information is requested by the federal government for certain types of loans related to a dwelling 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 on the basis of this information, nor on whether you choose to furnish it. If you do not want to furnish this information, select the box below.
Borrower Co-borrower
I do not wish to furnish this information

Race/National Origin:

Sex: Female Male

 I do not wish to furnish this information

Race/National Origin:

Sex: Female Male
1. Type of Mortgage and Terms of Loan
Mortgage Applied for:
Loan Amount:
Interest Rate: %
No. of Months:
Amortization Type:
2. Property Information and Purpose of Loan
Subject Property Address:
City:
State:
ZIP Code:
Number of Units:
Purpose of Loan:
Property Will Be:
Purchase Price or Estimated Value:
Source of Down Payment, Settlement Charges, and/or Subordinate Financing:
Estate Will Be Held in:
Complete the items below if this is a construction, construction-permanent, or refinance loan:
3. Borrower Information
First Name: *
Middle Initial:
Last Name: *
Generation Suffix (if applicable):
(for example, Jr., Sr., or II)