Mortgage Loan Application

 

Contact the Citizens Bank of Kansas Mortgage Lending expert in your area: 

Tom Wagner, NMLS# 458607

West Wichita  316.729.8800

Ben Drouhard, NMLS # 458605

East Wichita  316.684.2265

Monty Applebee, NMLS# 458612

Rural Development Specialist

785.445.5164

Courtney Hardgrave, NMLS# 1002678

Kingman   620.532.5162

Teresa Bradbury, NMLS# 458610

Winfield  620.221.4230

Debbie Winter, NMLS# 926481

Medicine Lodge   620.886.5686

Mortgage Application

Please complete all boxes and fields below.  
APPLICANT #1 
* indicates required fields
FULL NAME (First Middle Last) SOCIAL SECURITY #

*   *

*
WORK PHONE #                                                          HOME PHONE #   EMAIL ADDRESS
                             * *
DATE OF BIRTH YEARS OF SCHOOL COMPLETED
*
MARITAL STATUS # OF DEPENDENTS         AGES
* *          
HOME ADDRESS
*  
CITY                                                        STATE                                        ZIP
* ,*   *
YEARS AT PRESENT ADDRESS CURRENT RESIDENTIAL STATUS
*   *
PRESENT EMPLOYER NAME SELF EMPLOYED                        PERCENT OF BUSINESS OWNED
*                                          
TYPE OF BUSINESS YEARS IN THIS TYPE OF WORK
EMPLOYER ADDRESS
*
CITY                                                    STATE                                 ZIP
* , *  *
POSITION/TITLE YEARS IN THIS POSITION
* *  
PHONE NUMBER
*
GROSS MONTHLY SALARY
*
OTHER INCOME (alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.)
SOURCE MONTHLY AMOUNT
If you answer "Yes" to any questions a through i, please provide an explanation.    
a.  Are there any outstanding judgments against you?
     Explanation        
b.  Have you been declared bankrupt within the past seven years?
     Explanation        
c.  Have you had property foreclosed upon or given title or deed in lieu thereof in the last seven years?
     Explanation        
d.  Are you a party to a lawsuit?
     Explanation        
e.  Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of 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 action.
     Explanation        
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," give details as described in the preceding question.
     Explanation        
g.  Are you obligated to pay alimony, child support or separate maintenance?
     Explanation        
h.  Is any part of the down payment borrowed?
     Explanation        
i.  Are you a co-maker or endorser on a note?
     Explanation        
j.  Citizenship? *
k.  Have you had an ownership interest in a property in the last three years?
1) What type of property did you own-- principal residence, second home or investment property?
2) How did you hold title to the home-- solely by yourself, jointly with your spouse  or jointly with another person?

 

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 not discriminate either on the basis of this information, or on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may choose more than one designation. If you do not furnish ethnicity, race or sex, under Federal regulations the lender is required to note the information on the basis of visual observation and surname if you have made this application in person. If you do not wish to furnish the information, please indicate your choice by checking the box provided.

  I do not wish to furnish this information.
l.  Ethnicity
m.  Race
     Additional Race
     Additional Race
     Additional Race
n.  Sex
APPLICANT #2
FULL NAME (First Middle Last) SOCIAL SECURITY #
 
WORK PHONE #                                                      HOME PHONE #   EMAIL ADDRESS
                               
DATE OF BIRTH YEARS OF SCHOOL COMPLETED
MARITAL STATUS # OF DEPENDENTS     AGES
   
HOME ADDRESS
CITY                                                STATE                                     ZIP
,
YEARS AT PRESENT ADDRESS CURRENT RESIDENTIAL STATUS
     
PRESENT EMPLOYER NAME SELF EMPLOYED                       PERCENT OF BUSINESS OWNED
                                
TYPE OF BUSINESS YEARS IN THIS TYPE OF WORK
EMPLOYER ADDRESS
CITY                                                    STATE                                  ZIP
,
POSITION/TITLE YEARS IN THIS POSITION
 
PHONE NUMBER
GROSS MONTHLY SALARY
OTHER INCOME (alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.)
SOURCE MONTHLY AMOUNT
If you answer "Yes" to any questions a through i, please provide an explanation.
a.  Are there any outstanding judgments against you?
     Explanation        
b.  Have you been declared bankrupt within the past seven years?
     Explanation        
c.  Have you had property foreclosed upon or given title or deed in lieu thereof in the last seven years?
     Explanation        
d.  Are you a party to a lawsuit?
     Explanation        
e.  Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of 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 action.
     Explanation        
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," give details as described in the preceding question.
     Explanation        
g.  Are you obligated to pay alimony, child support or separate maintenance?
     Explanation        
h.  Is any part of the down payment borrowed?
     Explanation        
i.  Are you a co-maker or endorser on a note?
     Explanation        
j.  Citizenship?
k.  Have you had an ownership interest in a property in the last three years?
1) What type of property did you own-- principal residence, second home or investment property?
2) How did you hold title to the home-- solely by yourself, jointly with your spouse  or jointly with another person?

 

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 not discriminate either on the basis of this information, or on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may choose more than one designation. If you do not furnish ethnicity, race or sex, under Federal regulations the lender is required to note the information on the basis of visual observation and surname if you have made this application in person. If you do not wish to furnish the information, please indicate your choice by checking the box provided.
  I do not wish to furnish this information. 
l.  Ethnicity
m.  Race
     Additional Race
     Additional Race
     Additional Race
n.  Sex
LOAN/PROPERTY INFORMATION 
PURPOSE OF LOAN
DOWN PAYMENT AVAILABLE
LOAN AMOUNT REQUESTED
*
PROPERTY USE
 PRESENT MONTHLY HOUSING
 RENT
 
FIRST MORTGAGE
ASSETS

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

ACCOUNT TYPE
*
INSTITUTION (include banks, credit unions, S&Ls, etc.)
*
ADDRESS
CITY                                                    STATE                                  ZIP
,  
ACCOUNT # BALANCE
*
ACCOUNT TYPE
INSTITUTION (include banks, credit unions, S&Ls, etc.)
ADDRESS
CITY                                                    STATE                                  ZIP
ACCOUNT # BALANCE
OTHER ASSETS
CASH VALUE STOCKS, BONDS, SECURITIES COMPANY
GIFT
CASH VALUE OF LIFE INSURANCE (if source of down payment)
RETIREMENT FUNDS (vested)
OTHER (if source of down payment) DESCRIPTION
REAL ESTATE OWNED
ADDRESS #1
CITY                                                    STATE                                  ZIP
,
PROPERTY TYPE
PRESENT MARKET VALUE GROSS RENTAL INCOME
ADDRESS #2
CITY                                                    STATE                                  ZIP
,
PROPERTY TYPE
PRESENT MARKET VALUE GROSS RENTAL INCOME

I/We have applied for credit from the Lender. As part of the application process, the Lender and any potential investor or insurer of this loan may verify the information contained in my/our credit application and in other documents required in connection with this loan.                                                       

I/We authorize you to provide to the Lender and to any potential investor or insurer of this loan, any and all information and documentation requested.  Such information may include, but is not limited to:  employment and income history, bank, money market and similar account balances; credit history; and copies of income tax returns.  The source of the information may come from, but is not limited to:  credit bureaus; banks and other depository institutions; current and former employers; federal or state records including State Employment Security Agency (SESA) records; or other sources as required.

This authorization to access employment and income history from federal or state records including SESA records, for this transaction continues in effect for one (1) year unless limited by state law, in which case the authorization continues in effect for the maximum period, not to exceed one (1) year, allowed by law.

Certification:  I/We certify that the information provided in this application is true and correct as of the date submitted by clicking "Submit Application" below. I/we acknowledge my/our understanding that any 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, its agents, successors and assigns, insurers and any other person who may suffer any loss due to reliance upon any misrepresentations which I/We have made on this application.