Mortgage Loan Application

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.

 

Mortgage applied for:   Conventional USDA/Rural Housing Service Other (explain)

Loan amount

Purchase Price (if applicable)

Purpose of the loan: Purchase Construction Refinance

Property Information: (This section is not required for pre-qualification. Go directly to Borrower Information)

City State

Number of Units

If this is a refinance transaction, please complete the following:

Year acquired Original Cost Amount of Existing Liens

Purpose of refinance

Describe Improvements Made since purchase or To be made with loan proceeds

Borrower Information

Name of Borrower #1 Date of Birth mo/dd/year

Social Security Number xxx-xx-xxxx   Driver's License Number

Home Phone Cell Phone Marital Status

Address City State Zip

Years at this address Rent Own

Previous Address (if at current for less then 2 years)
Address City State Zip

Mailing Address (if different from present address)
Address City State Zip

Number of Dependents Ages of Dependents

Employer Years on the job

Years in this line of work or profession: Title/Type of Business

Employer Address City State Zip

Employer Phone

Previous Employer (if at current less then 2 years) Phone

 

Application to be completed:

Jointly (If Jointly Please Fill out Co-Borrower Information)
Not Jointly (Proceed to Financial Information)

Co-Borrower Information

Name of Borrower #2 Date of Birth mo/dd/year

Social Security Number xxx-xx-xxxx   Driver's License Number

Home Phone Cell Phone Marital Status

Address City State Zip

Years at this address Rent Own

Previous Address (if at current for less then 2 years)
Address City State Zip

Mailing Address (if different from present address)
Address City State Zip

Number of Dependents Ages of Dependents

Employer Years on the job Phone

Years in this line of work or profession: Title/Type of Business

Employer Address City State Zip

Previous Employer (if at current less then 2 years) Phone

Financial Information

Please note: Alimony, child support or separate maintenance income need not be revealed if the borrower (B) or co-Borrower (C) 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)

Gross Monthly Income (Assets)

Borrower Other Income (if any) Type

Co-borrower Other Income (if any) Type

Current Monthly Housing Expenses

Rent First Mortgage: Second Mortgage

Hazard Insurance Property Taxes

Mortgage Insurance H. O. Assn Dues

List Checking & Savings Account Information Below

Bank Name Address

Account Number Account value

Bank Name Address

Account Number Account value

Bank Name Address

Account Number Account value

Stocks & Bonds Description Value

Life Insurance Face Amount Cash Value

Real Estate Owned:
Property Address Address City State Zip

Estimated Value

Property Address Address City State Zip

Estimated Value

Vested interest in retirement plan:

Net worth of business owned:

Car #1 Make Year Value

Car # 2 Make Year Value

Other asset: Value

Other asset: Value

Current Monthly Payments: (Liabilities)

Name of Company Payment

Name of Company Payment

Name of Company Payment

Name of Company Payment

Name of Company Payment

Name of Company Payment

Name of Company Payment

Declarations

Borrower

a. Are there any judgments against you? Yes No         Co-borrower Yes No

b. Have you been declared bankrupt within the past 7 years? Yes No         Co-borrower Yes No

c. Have you had property foreclosed on or given title or deed in lieu of w/i 7 years? Yes No         Co-borrower Yes No

d. Are you a party to a lawsuit? Yes No         Co-borrower Yes No

e. Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer or 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 please provide details, including name & address of lender, FHA or VA case number, if any, and give reasons for the action below)

Yes No         Co-borrower 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? If yes, please provide details in the comments box at the bottom of the form. Yes No         Co-borrower Yes No

g. Are you obligated to pay alimony, child support or separate maintenance? Yes No         Co-borrower Yes No

h. Is any part of the down payment borrowed? Yes No         Co-borrower Yes No

i. Are you a co-maker or endorser on a note? Yes No         Co-borrower Yes No

J. Are you a U.S. citizen? Yes No         Co-borrower Yes No

k. Are you a permanent resident alien? Yes No         Co-borrower Yes No

l. Do you intend to occupy the property as your primary residence? Yes No         Co-borrower Yes No (if yes complete question M below)

m. Have you had ownership interest in a property in the last three years? Yes No         Co-borrower Yes No

(1) what type of property did you own

(2) How did you hold title to the home

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 discriminate neither 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 he disclosures satisfy all requirements to which the lender is subject under applicable state law for the particular type of loan applied for.)

Borrower: I do not wish to furnish this information     Co-borrower: I do not wish to furnish this information

Ethnicity: Co-borrower: Ethnicity:

Race: Co-borrower: Race:

Sex: Co-borrower: Sex:

Acknowledgment and Agreement

Please click here to view the acknowledgement and agreement.

I/we have read the acknowledgment and agreement.

In the box below, please let us know of any comments and the best method of contacting you.