This application is designed to be completed by
the applicant(s). Applicants should complete this form as "Borrower" or
"Co-Borrower" as applicable. Co-borrower information must also be provided (and
the appropriate box checked below) when:
Click here if borrower and
co-borrower's income will be considered.
Click here if co-borrower's
income will not be considered.
Loan is secured by property in the State of:
I. Type Of Mortgage And Terms Of Loan
Mortgage applied for:
$
Loan Amount
%
Interest Rate
No. of Years
Amortization Type
$
Sales Price
$
Estimated Value (if refinancing)
II. Property Information And Purpose Of Loan
Subject Property Address
Street
City
State
Zip
No. of Units:
Year Built (est.):
Purpose of Loan:
Property will be:
Complete this line if this is a refinance loan.
Year Acquired
$
Original Cost
$
Existing Liens
Purpose of Refinance
III. Borrower Information
BORROWER
F
L
Name (include Jr. or Sr. if applicable) *F=first, MI, L=Last
Social Sec. No.
Home Phone
Age
Yrs. of School
Marital Status
Married
Unmarried
Separated
Dependents
No.
Ages
PRESENT
ADDRESS
Street
City
State
Zip
Own Rent
No. Years
If at present address less than two years complete the following:
FORMER
ADDRESS 1
Street
City
State
Zip
Own Rent
No. Years
FORMER
ADDRESS 2
Street
City
State
Zip
Own Rent
No. Years
CO-BORROWER
F L
Name (include Jr. or Sr. if applicable) *F=first, MI,
L=Last
Social Sec. No.
Home Phone
Age
Yrs. of School
Marital Status
Married
Unmarried
Separated
Dependents
No.
Ages
PRESENT
ADDRESS
Street
City
State
Zip
Own Rent
No. Years
If at present address less than two years complete the following:
FORMER
ADDRESS 1
Street
City
State
Zip
Own Rent
No. Years
FORMER
ADDRESS 2
Street
City
State
Zip
Own Rent
No. Years
IV. Employment Information
BORROWER
Name of
Employer..... Self
Employed
Address
City
State
Zip
Position/Title
(inc area code)
Business Phone
Yrs. on Job:
Years in this line of profession:
CO-BORROWER
Name of
Employer..... Self Employed
Address
City
State
Zip
Position/Title
(inc area code)
Business Phone
Yrs. on Job:
Years in this line of
profession:
If employed in current position for less than 2 years or if currently
employed in more than 1 position, complete the following:
BORROWER
(Previous Employer 1)
Name of
Employer..... Self Employed
Address
City
State
Zip
Position/Title
(inc area code)
Business Phone
Start Date
End Date
BORROWER (Previous Employer 2)
Name of
Employer..... Self Employed
Address
City
State
Zip
Position/Title
(inc area code)
Business Phone
Start Date
End Date
CO-BORROWER
(Previous Employer 1)
Name of
Employer..... Self Employed
Address
City
State
Zip
Position/Title
(inc area code)
Business Phone
Start Date
End Date
CO-BORROWER (Previous Employer 2)
Name of
Employer..... Self Employed
Address
City
State
Zip
Position/Title
(inc area code)
Business Phone
Start Date
End Date
V. Monthly Income And Combined
Housing Expense Information
Gross Monthly Income
Borrower
Co-Borrower
Combined Mthly Housing
Exp.
Present
Base Empl. Income * **
Rent
Overtime
First
Mortgage (P&I)
Bonuses
Other
Financing (P&I)
Commissions
Hazard Insurance
Dividends/Interest
Real Estate Taxes
Net Rental Income
Mortgage Insurance
Other:
Homeowner Assn. Dues
Other:
* Self employed borrower (s) may be required to
provide additional documentation such as tax returns & financial statements.
** Show approximately 18-24 average monthly income or
salary per month.
Describe other income: Notice: Please
describe monthly income from other sources. Include SSI, pension, alimony, child support, etc., if you would like it
considered. Select borrower or co-borrower.
Monthly
Amount
VI. Assets And Liabilities
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. Completed:
JointlyNot Jointly
Assets
Cash or
Market Value
Liability and Pledged assets. List
the creditors name, address and account # for all outstanding debts, including auto loans,
revolving charge accounts, real estate loans, alimony, child support, stock pledges, etc.
Use continuation sheet, if necessary. Indicate by (
*) those liabilities which will be
satisfied upon sale of real estate owned or upon refinancing of the subject property.
Earnest Money to Purchase
Held by:
$
List checking and savings
accounts below, name & address of Bank S&L, Credit Union, Retirement, Brokerage,
etc..
Liabilities
Monthly Payments
Name
*
Name
$
Pmt Amount
Acct #
$
Last Statement Balance
Acct #
$
Unpaid Balance
Name
Name
$
Pmt Amount
Acct #
$
Last Statement Balance
Acct #
$
Unpaid Balance
Name
Name
$
Pmt Amount
Acct #
$
Last Statement Balance
Acct #
$
Unpaid Balance
Name
Name
$
Pmt Amount
Acct #
$
Last Statement Balance
Acct #
$
Unpaid Balance
Name
Name
$
Pmt Amount
Acct #
$
Last Statement Balance
Acct #
$
Unpaid Balance
*
please insert
"none" here if you have no liabilities
Additional Assets
Value
Additional Liabilities
Monthly Payment
Life insurance net cash value Face amt.:
$
If cashed in:
Name
$
Pmt Amount
Acct #
$
Unpaid Balance
Name
$
Pmt Amount
Acct #
$
Unpaid Balance
Alimony/Child
Support/Separate maintenance pmts owed to:
$
Job related
expense (union dues, etc.):
$
Schedule of Real Estate Owned:
(if additional properties are owned, use continuation
sheet available at the end of this application.)
Property Address
Type of
Property
Present Market
Value
Amount of Mtg.
& Leans
Gross Rental
Income
Mtg. Payments
Insurance,
Maint, Misc..
List any
additional names under which credit has previously been granted and indicate appropriate
creditor name (s) and account number (s):
Alternate
Name
Creditor
Name
Account
Number
VII. Declarations
Please Answer the
Following Questions (leave blank if not applicable)
BORROWER
CO-BORROWER
a. Are there any outstanding
judgments against you?
Yes
No
Yes
No
b. Have you been declared
bankrupt within the last 7 years?
Yes
No
Yes
No
c. Have you had property
foreclosed upon in the last 7 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?
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 the 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 3 years?
Yes
No
Yes
No
BORROWER
CO-BORROWER
1. What type of property did you or do you
own?
2. How did or do you hold title to the
home?
VIII. Acknowledgement And Agreement
The undersigned specifically
acknowledge
and agree(s) that:(1) The loan requested by this application will be secured by a first
mortgage or deed of trust on the property. Described herein; (2) the property will not be
used for any illegal or prohibited purpose or use; (3) all statements made in this
application are made for the purpose of obtaining the loan indicated herein; (4)
occupation of the property will be as indicated above; (5) verification or re-verification
of any information contained in the application may be made at any time by the lender,
it's agents, successors and assigns, either directly or through a credit reporting agent,
from any source named in this application, and the original copy of this application will
be retained by the lender, even if the loan is not approved; (6) the lender, it's agents,
successors and assigns will rely on the information contained in the application and I/we
have a continuing obligation to amend and/or supplement the information provided in this
application if any of the material facts which I/we have represented herein should change
prior to closing; (7) in the event my/our payments on the loan indicated in this
application become delinquent, the lender, it's agents, successors and assigns, may, in
addition to all their other rights and remedies, report my/our name(s) and account
information to a credit reporting agency; (8) ownership of the loan may be transferred to
successor or assign of the lender without notice to me and/or the administration of the
loan account may be transferred to an agent, successor or assign of the lender with prior
notice to me; (9) the lender, it's agents, successors and assigns make no representations
or warranties, expressed or implied, to the borrower(s) regarding the property, the
condition of the property, or the value of the property. Certification; I/we certify that the information provided in this
application is true and correct as of the date set forth opposite my/our signature(s) on
this application and acknowledge my/our understanding that my intentional or negligent
misrepresentation(s) of the information contained in this application may result in civil
liability and/or criminal penalties including, but not limited to, fine or imprisonment or
both under the provisions of title 18, United States Code, Section 1001, et seq. and
liability for monetary damages to the lender, it's agents, successors and assigns,
insurers and any other person who may suffer any loss due to the reliance upon any
misrepresentation which I/we have made on this application.
Borrowers Name
Date
Co-Borrowers Name
Date
IX. Information For Government Monitoring Purposes
The following information is requested by
the federal government for certain 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 neither discriminate on the basis
of this information, nor on whether you choose to furnish it. However, if you choose not
to furnish is, under federal regulations this lender is required to note race, and sex on
the basis of visual observation or surname. If you do not wish to furnish the above
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 furnish this information
Race/National Origin:
Sex: Female Male
I do not wish to furnish this information
Race/National Origin:
Sex: Female Male
Fire
insurance agent information
Name:
Phone number:
Real estate
Agent
Name:
Phone number:
E-Mail:
Thank you for completing the Online
Mortgage Application! If you need more space to add additional information, go to the
Continuation sheet below. We will contact you very shortly regarding your request.
Continuation Sheet/Residential Loan Application
Use this
continuation sheet if you need more space to complete the Residential Loan Application.
Copyright 1999-2000 EZdesk, Inc. All rights reserved.
Revised: November 06, 2010.