Mortgage Loan Inquiry

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

Type of Loan Conventional Mortgage Loan Home Equity Line of Credit

Purpose of Loan Purchase Refinance

Are you requesting a pre-approval? Yes No

Joint Application? Yes No

Purchase Price Loan Amount

Property Purpose Primary Residence 2nd Home Investment

Borrower Information

First Name Middle Initial Last Name Suffix Social Security Number Birth Date Cell Phone Number E-mail Address Please do NOT email me important news and updates.

Marital Status Unmarried Married Separated

Current Residence

Home Address City State Zip Code Mailing address is different than street address.

Mailing Address City State Zip Code

Do you own or rent this property? Own Rent Other

Explain Monthly Mortgage or Rent Payment

Have you lived here for two or more years? Yes No

Previous Home Address City State Zip Code

Did you own or rent this property? Own Rent Other

Explain Monthly Mortgage or Rent Payment

Employment Information

Is the borrower employed? Employed Not Employed

Name of Employer Employer's Address City State Zip Code Employer's Phone Number

Have you worked here for more than two years? (Select “No” if unemployed). If no, who is your previous employer? Yes No

Previous Employer

Name of Employer Employer's Address City State Zip Code Employer's Phone Number

Co-Borrower Information

First Name Middle Initial Last Name Suffix Social Security Number Birth Date Cell Phone Number E-mail Address Please do NOT email me important news and updates.

Marital Status Unmarried Married Separated

Current Residence

Home Address City State Zip Code Mailing address is different than street address.

Mailing Address City State Zip Code

Do you own or rent this property? Own Rent Other

Explain Monthly Mortgage or Rent Payment

Have you lived here for two or more years? Yes No

Previous Home Address City State Zip Code

Did you own or rent this property? Own Rent Other

Explain Monthly Mortgage or Rent Payment

Employment Information

Is the borrower employed? Employed Not Employed

Name of Employer Employer's Address City State Zip Code Employer's Phone Number

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

Previous Employer

Name of Employer Employer's Address City State Zip 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 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

Provide Details N/A

Rent First Mortgage Second Mortgage Hazard Insurance Property Taxes Mortgage Insurance Home Owners Association Dues

Real Estate Owned

Provide Details N/A

Property

Property Address City State Zip Code Estimated Value Current Mortgage Amount Monthly Payment

Totals

Real Estate Market Value Mortgages & Liens

Monthly Totals

Mortgage Payments

Current Monthly Payments (Liabilities)

Provide Details N/A

Name of Company	Monthly Payment	Unpaid Balance
Name of Company	Monthly Payment	Unpaid Balance

Type of Debt Auto Student Loan Installment Credit Card Other

Explain

Borrower Declarations

List any additional names under which credit has previously been received and indicate appropriate creditor name(s) and account number(s)

Alternate Name	Creditor Name	Account Number
Alternate Name	Creditor Name	Account Number

Are there any outstanding judgments against you? Yes No

Explain

Have you been declared bankrupt within the past 7 years? Yes No

Explain

Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years? Yes No

Explain

Are you a party to a lawsuit? Yes No

Explain

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" provide details, including date, name and address of Lender, FHA or VA case number, if any, and reasons for the action.) Yes No

Explain

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. Yes No

Explain

Are you obligated to pay alimony, child support, or separate maintenance? Yes No

Explain

Is any part of the down payment borrowed? Yes No

Explain

Are you a co-maker or endorser on a note? Yes No

Explain

Are you a U.S. citizen? Yes No

Are you a permanent resident alien? Yes No

Explain

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

What type of property did you own? How did you hold the title to the home?

Co-Borrower Declarations

List any additional names under which credit has previously been received and indicate appropriate creditor name(s) and account number(s)

Alternate Name	Creditor Name	Account Number
Alternate Name	Creditor Name	Account Number

Are there any outstanding judgments against you? Yes No

Explain

Have you been declared bankrupt within the past 7 years? Yes No

Explain

Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years? Yes No

Explain

Are you a party to a lawsuit? Yes No

Explain

Are you obligated to pay alimony, child support, or separate maintenance? Yes No

Explain

Is any part of the down payment borrowed? Yes No

Explain

Are you a co-maker or endorser on a note? Yes No

Explain

Are you a U.S. citizen? Yes No

Are you a permanent resident alien? Yes No

Explain

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

What type of property did you own? How did you hold the title to the home?

Acknowledgement & Agreement

Each of the undersigned specifically represents to this Lender that:

The information provided in this document is true and correct as of the date set forth opposite my signature
If a Pre-Approval is requested, the undersigned will be required to submit sufficient documentation to Community Savings Bank to verify current employment and wages along with copies of tax returns and W2s for the previous two (2) years. Additionally, each of the undersigned hereby acknowledges and agrees that Community Savings Bank is authorized to verify any information contained in this document with a consumer reporting agency.
If this inquiry results in an application and a loan is approved, the loan will by secured by a mortgage on the subject property.

Type your name in the box below to represent your electronic signature.

Borrower's Signature Date

Co-Borrower's Signature Date

Type the numbers you see above:

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