Mortgage Loan Application

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Important Information About Procedures For Opening a New Account

To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account.

What this means for you: When you open an account, we will ask for your name, address, date of birth and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents and use third party identifiers such as chex systems and/or credit bureau reports.

Loan Information

Are you applying for joint credit?(Required)

Yes

What type of mortgage are you applying for?(Required)

Conventional

USDA/Rural Housing Service

Other

($) Total Loan Amount(Required)

($) Purchase Price(Required)

Purpose of Loan

Purchase

Refinance

Construction

Is this application for pre-qualification?

Yes

Property Information

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Number of Units(Required)

Refinance

Year Aquired(Required)

($) Original Cost(Required)

($) Amount of Existing Liens(Required)

Purpose of Refinance(Required)

Will this be used for improvements?(Required)

Yes

Improvements have already been made

Describe Improvements(Required)

Borrower Information

Name(Required)

First Middle Last Suffix

Social Security Number(Required)

Birth Date(Required)

Mothers Maiden Name

Phone(Required)

Housing

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Mailing address is different than street address.

Mailing Address

Street Address City State / Province / Region ZIP / Postal Code

Do you own or rent this property?(Required)

Own

Rent

Other

Residency Start Date(Required)

($) Monthly Mortgage or Rent Payment

Have you lived here for two or more years?(Required)

Yes

Previous Home Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Did you own or rent this property?(Required)

Own

Rent

Other

Residency Start Date(Required)

($) Monthly Mortgage or Rent Payment(Required)

Marital Status

Number of Dependents (Not Listed by Co-Borrower)(Required)

List Dependents' Ages

Employment Information

Is the borrower employed?(Required)

Employed

Not Employed

Employment Start Date(Required)

Position or Title(Required)

($) Gross Monthly Income(Required)

Name of Employer(Required)

Employer's Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Employer's Phone Number(Required)

Have you worked here for more than two years? (No if unemployed)

Yes

Co-Borrower Information

Name

First Middle Last Suffix

Social Security Number

Birth Date

Mothers Maiden Name

Phone

Housing

Address

Street Address City State / Province / Region ZIP / Postal Code

Co Borrower Checkbox

Mailing address is different than street address

Address

Street Address City State / Province / Region ZIP / Postal Code

Do you own or rent this property?

Own

Rent

Other

Residency Start Date

($) Monthly Mortgage or Rent Payment

Have you lived here for two or more years?

Yes

Previous Home Address

Street Address City State / Province / Region ZIP / Postal Code

Do you own or rent this property?

Own

Rent

Other

Residency Start Date

($) Monthly Mortgage or Rent Payment

Marital Status

Number of Dependents

List Dependents' Ages

Employment Information

Is the co-borrower employed?

Employed

Not Employed

Employment Start Date

Position or Title

($) Gross Monthly Income

Name of Employer

Employer's Address

Street Address City State / Province / Region ZIP / Postal Code

Employer's Phone Number

Have you worked here for more than two years? (No if unemployed)

Yes

Employment Start Date

Position or Title

($) Gross Monthly Income

Name of Employer

Employer's Address

Street Address City State / Province / Region ZIP / Postal Code

Employer's Phone Number

Previous Employer

Employment Start Date

Position or Title

($) Gross Monthly Income

Name of Employer

Employer's Address

Street Address City State / Province / Region ZIP / Postal Code

Employer's Phone Number

Financial Information

Please note: Alimony, child support or separate maintenance income need not be revealed if the Borrower or Co-Borrower does not choose to have it considered for repaying this loan. Also self employed borrowers may be required to provide additional documentation such as tax returns and financial statements. (before taxes)

Borrower's Gross Monthly Income

($) Monthly Salary & Wages(Required)

($) Other Monthly Income (if any)

Income Type

Co-Borrower's Gross Monthly Income

($) Monthly Salary & Wages

($) Other Monthly Income (if any)

Income Type

Current Monthly Housing Expenses

($) Rent

($) First Mortgage

($) Second Mortgage

($) Hazard Insurance

($) Mortgage Insurance

($) Property Taxes

($) Home Owners Association Dues

Checking or Savings

Please list all checking and savings accounts.

Account 1

Bank Name

Bank Address

Street Address City State / Province / Region ZIP / Postal Code

Account Number

($) Account Balance

Do you want to add another account?

Yes

Account 2

Bank Name

Bank Address

Street Address City State / Province / Region ZIP / Postal Code

Account Number

($) Account Balance

Do you want to add another account?

Yes

Account 3

Bank Name

Bank Address

Street Address City State / Province / Region ZIP / Postal Code

Account Number

($) Account Balance

Do you want to add another account?

Yes

Account 4

Bank Name

Bank Address

Street Address City State / Province / Region ZIP / Postal Code

Account Number

($) Account Balance

Do you want to add another account?

Yes

Account 5

Bank Name

Bank Address

Street Address City State / Province / Region ZIP / Postal Code

Account Number

($) Account Balance

Do you want to add another account?

Yes

Account 6

Bank Name

Bank Address

Street Address City State / Province / Region ZIP / Postal Code

Account Number

($) Account Balance

Do you want to add another account?

Yes

Account 7

Bank Name

Bank Address

Street Address City State / Province / Region ZIP / Postal Code

Account Number

($) Account Balance

Do you want to add another account?

Yes

Account 8

Bank Name

Bank Address

Street Address City State / Province / Region ZIP / Postal Code

Account Number

($) Account Balance

Do you want to add another account?

Yes

Account 9

Bank Name

Bank Address

Street Address City State / Province / Region ZIP / Postal Code

Account Number

($) Account Balance

Do you want to add another account?

Yes

Account 10

Bank Name

Bank Address

Street Address City State / Province / Region ZIP / Postal Code

Account Number

($) Account Balance

Do you want to add another account?

Yes

Account 11

Bank Name

Bank Address

Street Address City State / Province / Region ZIP / Postal Code

Account Number

($) Account Balance

Stocks & Bonds

Description

($) Total Value

Life Insurance

($) Face Amount

($) Cash Value

Real Estate

Property 1

Property Address

Street Address City State / Province / Region ZIP / Postal Code

Estimated Value

Do you want to add another property?

Yes

Property 2

Property Address

Street Address City State / Province / Region ZIP / Postal Code

Estimated Value

Do you want to add another property?

Yes

Property 3

Property Address

Street Address City State / Province / Region ZIP / Postal Code

Estimated Value

Do you want to add another property?

Yes

Property 4

Property Address

Street Address City State / Province / Region ZIP / Postal Code

Estimated Value

Do you want to add another property?

Yes

Property 5

Property Address

Street Address City State / Province / Region ZIP / Postal Code

Estimated Value

Do you want to add another property?

Yes

Property 6

Property Address

Street Address City State / Province / Region ZIP / Postal Code

Estimated Value

Do you want to add another property?

Yes

Property 7

Property Address

Street Address City State / Province / Region ZIP / Postal Code

Estimated Value

Do you want to add another property?

Yes

Property 8

Property Address

Street Address City State / Province / Region ZIP / Postal Code

Estimated Value

Do you want to add another property?

Yes

Property 9

Property Address

Street Address City State / Province / Region ZIP / Postal Code

Estimated Value

Do you want to add another property?

Yes

Property 10

Property Address

Street Address City State / Province / Region ZIP / Postal Code

Estimated Value

Do you want to add another property?

Yes

Property 11

Property Address

Street Address City State / Province / Region ZIP / Postal Code

Estimated Value

Miscellaneous Assets

($) Vested Interest in Retirement plan

($) Net Worth of Business Owned

Automobile 1

Year

Make

Model

($) Estimated Value

Do you want to add another automobile?

Yes

Automobile 2

Year

Make

Model

($) Estimated Value

Do you want to add another automobile?

Yes

Automobile 3

Year

Make

Model

($) Estimated Value

Do you want to add another automobile?

Yes

Automobile 4

Year

Make

Model

($) Estimated Value

Do you want to add another automobile?

Yes

Automobile 5

Year

Make

Model

($) Estimated Value

Do you want to add another automobile?

Yes

Automobile 6

Year

Make

Model

($) Estimated Value

Do you want to add another automobile?

Yes

Automobile 7

Year

Make

Model

($) Estimated Value

Do you want to add another automobile?

Yes

Automobile 8

Year

Make

Model

($) Estimated Value

Do you want to add another automobile?

Yes

Automobile 9

Year

Make

Model

($) Estimated Value

Do you want to add another automobile?

Yes

Automobile 10

Year

Make

Model

($) Estimated Value

Do you want to add another automobile?

Yes

Automobile 11

Year

Make

Model

($) Estimated Value

Other Assets

Description

Total Value

Current Monthly Payments (Liabilities)

Name of Company

Monthly Payment

Declarations

Alternate Name

Creditor Name

Account Number

Borrower

Are there any outstanding judgments against you?(Required)

Yes

If yes, Explain(Required)

Have you been declared bankrupt within the past 7 years?(Required)

Yes

If yes, Explain(Required)

Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?(Required)

Yes

If yes, Explain(Required)

Are you a party to a lawsuit?(Required)

Yes

If yes, Explain(Required)

Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer or title in lieu of foreclosure, or judgment?(Required)

Yes

(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.)

If yes, Explain(Required)

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.(Required)

Yes

If yes, Explain(Required)

Are you obligated to pay alimony, child support, or separate maintenance?(Required)

Yes

If yes, Explain(Required)

Is any part of the down payment borrowed?(Required)

Yes

If yes, Explain(Required)

Are you a co-maker or endorser on a note?(Required)

Yes

If yes, Explain(Required)

Are you a U.S. citizen?(Required)

Yes

Are you a permanent resident alien?(Required)

Yes

If yes, Explain(Required)

Do you intend to occupy the property as your primary residence?(Required)

Yes

Have you had an ownership interest in a property in the last three years?(Required)

Yes

Select type of property owned(Required)

Select how the property was held(Required)

Co-Borrower

Are there any outstanding judgements against you?

Yes

If yes, Explain

Have you been declared bankrupt within the past 7 years?

Yes

If yes, Explain

Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?

Yes

If yes, Explain

Are you a party to a lawsuit?

Yes

If yes, Explain

Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer or title in lieu of foreclosure, or judgment?

Yes

If Yes, Explain

Yes

If yes, Explain

Are you obligated to pay alimony, child support, or separate maintenance?

Yes

If yes, Explain

Is any part of the down payment borrowed?

Yes

If yes, Explain

Are you a co-maker or endorser on a note?

Yes

If yes, Explain

Are you a U.S. citizen?

Yes

Are you a permanent resident alien?

Yes

If yes, Explain

Do you intend to occupy the property as your primary residence?

Yes

Have you had an ownership interest in a property in the last three years?

Yes

Select type of property owned

Select how the property was held

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 on the basis of this information, nor 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 or surname. If you do not wish to furnish that 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

Participate

I would like to participate

Select Ethnicity(Required)

Select Race(Required)

Select Sex(Required)

Co-Borrower

Co Borrower Participate

I would like to participate

Select Ethnicity(Required)

Select Race(Required)

Select Sex(Required)

Acknowledgement & Agreement

Each of the undersigned specifically represents to Lender and to Lender's 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 services, 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 credit 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.
I/We fully understand that it is a Federal crime punishable by fine or imprisonment, or both, to knowingly make any false statements concerning any of the above facts as applicable under the provisions of Title 18, United States Code, Section 1001, et seq.
Type your name in the box below to represent your electronic signature.

Borrower's Signature(Required)

Signature

Date

Co-Borrower's Signature(Required)

Signature

Date

Disclosure Acceptance(Required)

Yes, I have read the Real Estate Application Disclosure.