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.

Required Field

Loan Information

Are you applying for joint credit?

Purpose of Loan

Purchase
Refinance
Construction
Home Improvement

Borrower Information

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

Housing

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

Residency Start Date Monthly Mortgage or Rent Payment

Have you lived here for two or more years?

Previous Home Address City State Zip Code

Did you own or rent this property?

Own
Rent
Other
Explain

Residency Start Date Monthly Mortgage or Rent Payment

Marital Status

Single
Married
Separated
Divorced
Widowed

Number of Dependents (Not Listed by Co-Borrower) List Dependents' Ages

Employment Information

Is the borrower employed?

Employed
Not Employed

Employment Start Date Position or Title Gross Monthly Income 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)

Previous Employer

Employment Start Date Position or Title Gross Monthly Income 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 Mother's Maiden Name Home Phone Number E-mail Address Please do NOT email me important news and updates.

Housing

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

Residency Start Date Monthly Mortgage or Rent Payment

Have you lived here for two or more years?

Previous Home Address City State Zip Code

Did you own or rent this property?

Own
Rent
Other
Explain

Residency Start Date Monthly Mortgage or Rent Payment

Marital Status

Single
Married
Separated
Divorced
Widowed

Number of Dependents (Not Listed by Co-Borrower) 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 City State Zip Code Employer's Phone Number

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

Previous Employer

Employment Start Date Position or Title Gross Monthly Income 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

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

Borrower

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?

Are you a permanent resident alien?

Yes
No
Explain

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

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

Type of Property Owned How the Property Was Held

Co-Borrower

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

Yes
No
Explain

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?

Are you a permanent resident alien?

Yes
No
Explain

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

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

Type of Property Owned How the Property Was Held

Endorsement

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 Date Co-Borrower's Signature Date

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