Mortgage Applied For:

V.A
FHA
Conventional
FmHA
Other

Amount:

Interest Rate:

No. of Months:

Amortization Type:

Fixed Rate GPM ARM Other

Subject Property Address (street, city, state, zip):

Legal Description of Subject Property (attach description if necessary):

Purpose of Loan

Purchase Refinance Construction  Construction-Permanent Other                   

Property will be:

Primary Residence  Secondary Residence  Investment

Year lot acquired:

Original Cost $:

Amount of existing liens$:

Present Value of Lot $:

Cost of improvements $:

Cost of improvements to be done $:

Total $:

Year Acquired:

Original Cost $:

Amount of existing liens $:

Purpose of refinance:

Describe Improvements made:

Describe improvements to be made:

Cost of Improvements $:

Title will be held in what Name (s):

Manner in which title will be held:

Estate will be held in:

Fee Simple
Lease Hold (show expiration date)

Source of down payment, settlement charges and/or subordinate financing (explain)

Borrower's Name (include Jr. or Sr. if applicable)

Social Security Number:

Home Phone (include area code):

Age:    Years of Schooling:

Marital Status

Married
Separated
Unmarried (include single, divorced, widowed)

Number of dependents:

Ages:

Present Address:

Own: Yes No

No of Years:

IF RESIDING AT THE CURRENT ADDRESS FOR LESS THAN 2 YEARS FILL IN THE FORMER ADDRESS INFORMATION:

Former Address:

Own: Yes No

No of Years:

Name and address of employer:

Self Employed: Yes No

Years on this job:

Years employed in this line of work/profession:

Position/Title/Type of Business:

Phone Number:

IF EMPLOYED IN CURRENT POSITION FOR LESS THAN 2 YEARS FILL IN THE PREVIOUS EMPLOYER INFORMATION:

Name and Address of Previous Employer:

Self Employed: Yes No

Dates From: -- mm/dd/yy

Dates To: -- mm/dd/yy

Monthly Income $:

Phone Number:

Position / Title / Type of Business:

Co-Borrower Name:

Social Security Number:

Home Phone:

Age:

Years of School:

Marital Status

Married
Separated
Unmarried (Include single, divorced, widowed)

Dependents:

Ages:

Present Address:

Own: Yes No

No. of years:

Former Address:

No of Years:

Name and address of employer

Self Employed: Yes No

Years on this job:

Years employed in this line of work/profession:

Position/Title/Type of Business:

Business Phone:

Name and address of former employer

Self Employed: Yes No

Date From:  -- mm/dd/yy

Date To: -- mm/dd/yy

Monthly Income:

Borrower's Gross Monthly Income (Include base employee income, overtime, bonuses, commissions, dividends/interest, net rental income $:

Co-Borrower's Gross Monthly Income (Include base employee income, overtime, bonuses, commissions, dividends/interest, net rental income $:

Combined Monthly Housing Expense (Include first mortgage, other financing, hazard insurance, real estate taxes, mortgage insurance, homeowner association dues, other) $:

Describe other income:

Other Income Monthly Amount $:

ASSETS

Cash deposit toward purchase held by:

Name and address of bank where checking account is maintained.

Account Number:

Balance $:

Name and address of bank where savings account is maintained.

Account Number:

Balance $:

Name and address of other savings / S&L / Credit Union.

Account Number:

Balance $:

List all stocks & bonds (Company name / number & description)

Cash or Market Value $:

Life insurance net cash value $:

Real estate owned (enter market value from schedule of real estate owned)

$ :

Vested interest in retirement fund $:

Automobiles owned (make / model / year)

Value of automobile (s) $:

Other cash assets $:

LIABILITIES

Liabilities and pledged assets. List the creditor's names, addresses, and account number for all outstanding debts, including automobile loans, revolving charge accounts, real estate loans, alimony, child support, stock pledges, etc.

Name and address of company

Account Number:

Monthly Payment $:

Balance $:

Name and address of company

Account Number:

Monthly Payment $:

Balance $:

Name and address of company

Account Number:

Monthly Payment $:

Balance $:

Are there any outstanding judgments against you?

Yes No

Have you ever been declared bankrupt within the past 7 years?

Yes No

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

Yes No

Are you party to a lawsuit?

Yes No

Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of the 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, VA case number.

Yes No

Are you presently delinquent or in default of any Federal debt or any other loan, mortgage, financial obligation bond, or loan guarantee? If yes provide details.

Yes No

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

Yes No

Is any part of down payment borrowed?

Yes No

Are you a co maker or endorser on a note?

Yes No

Are you a US citizen?

Yes No

Are you a permanent resident?

Yes No

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

Yes No

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

Yes No