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Type of Mortgage & Terms of Loan

  • Application Type *

Property Information & Purpose of Loan

  • Are you refinancing? *

Contact us for information on construction loans.

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Borrower Information

  • Borrower

    (Include Jr. or Sr. if applicable)
  • (Include area code)
  • (MM/DD/YYYY)
  • (If different from Present Address)
  • (If residing at present address for less than two years)
  • Co-Borrower

    (Include Jr. or Sr. if applicable)
  • (Include area code)
  • (MM/DD/YYYY)
  • (If different from Present Address)
  • (If residing at present address for less than two years)

Employment Information

  • Borrower

  • (Include area code)
  • (If employed in current position for less than two years or if currently employed in more than one position)
  • (Include area code)
  • (Include area code)
  • Co-Borrower

  • (Include area code)
  • (If employed in current position for less than two years or if currently employed in more than one position)
  • (Include area code)
  • (Include area code)

Monthly Income & Combined Housing Expense Information

Gross Monthly Income

Income Type Borrower Co-Borrower Total
Base Employment Income**
Net Rental Income

** Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.

Describe Other Income Notice: 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.

B/C Income Type Monthly Amount

Combined Monthly Housing Expense

Expense Type Present Proposed
First Mortgage (P&I)
Other Financing (P&I)
Hazard Insurance
Real Estate Tax
Mortgage Insurance
Homeowner Association Dues

Assets & 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 nonapplicant spouse or other person, this Statement and supporting schedules must be completed about that spouse or other person also.

  • Completed *
  • Assets

List checking & savings accounts below

  • (Company Name, Number & Description)
  • (Enter market value from schedule of real estate owned)
  • (Make & Year)
  • (Itemize)


Liabilities and Pledged Assets. List the creditor's name, address, and account number for all outstanding debts, including automobile 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.

Name & Address of Company Account No. Monthly Payment Unpaid Balance
  • (Child care, union dues, etc.)
  • (Total Assets minus Total Liabilities)

Schedule of Real Estate Owned

Property Address (enter S if sold, PS if pending sale or R if rental being held for income) Type of Property Present Market Value Amount of Mortgages & Liens Gross Rental Income Mortgage Payments Insurance, Maintenance, Taxes & Misc. Net Rental Income


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


Borrower Co-Borrower
    Yes No Yes No
a. Are there any outstanding judgments against you?
b. Have you been declared bankrupt within the past 7 years?
c. Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?
d. Are you a party to a lawsuit?
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.
f. Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee?
g. Are you obligated to pay alimony, child support, or separate maintenance?
h. Is any part of the down payment borrowed?
i. Are you a co-maker or endorser on a note?
j. Are you a U.S. citizen?
k. Are you a permanent resident alien?
l. Have you had an ownership interest in a property in the last three years?
  (1) What type of property did you own-principal residence (PR), second home (SH), or investment property (IP)?
  (2) How did you hold title to the home-solely by yourself (S), jointly with your spouse (SP), or jointly with another person (o)?

Acknowledgment & Agreement

Each of the undersigned specifically represents to Lender and to Lender's actual or potential agents, brokers, processors, attorneys, insurers, servicers, successors and assigns and agrees and acknowledges that: (1) the information provided in this application is true and correct as of the date set forth opposite my signature and that any intentional or negligent misrepresentation of this information contained in this application may result in civil liability, including monetary damages, to any person who may suffer any loss due to reliance upon any misrepresentation that I have made on this application, and/or in criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Sec. 1001, et seq.; (2) the loan requested pursuant to this application (the "Loan") will be secured by a mortgage or deed of trust on the property described in this application; (3) the property will not be used for any illegal or prohibited purpose or use; (4) all statements made in this application are made for the purpose of obtaining a residential mortgage loan; (5) the property will be occupied as indicated in this application; (6) the Lender, its servicers, successors or assigns may retain the original and/or an electronic record of this application, whether or not the Loan is approved; (7) the Lender and its agents, brokers, insurers, servicers, successors and assigns may continuously rely on the information contained in the application, and I am obligated to amend and/or supplement the information provided in this application if any of the material facts that I have represented herein should change prior to closing of the Loan; (8) in the event that my payments on the Loan become delinquent, the Lender, its services, successors or assigns may, in addition to any other rights and remedies that it may have relating to such delinquency, report my name and account information to one or more consumer credit reporting agencies; (9) ownership of the Loan and/or administration of the Loan account may be transferred with such notice as may be required by law; (10) neither Lender nor its agents, brokers, insurers, servicers, successors or assigns has made any representation or warranty, express or implied, to me regarding the property or the condition or value of the property; and (11) my transmission of this application as an "electronic record" containing my "electronic signature," as those terms are defined in applicable federal and/or state laws (excluding audio and video recordings), or my facsimile transmission of this application containing a facsimile of my signature, shall be as effective, enforceable and valid as if a paper version of this application were delivered containing my original written signature.

Acknowledgment. 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