PERSONAL LOAN / VISA APPLICATION

 

Mortgage Application

APPLICANT #1 
* indicates required fields
FULL NAME (First Middle Last) SOCIAL SECURITY #                  MEMBER NUMBER

*   *

*      
WORK PHONE #                                                          HOME PHONE #   EMAIL ADDRESS
*                             * *
DATE OF BIRTH
*
MARITAL STATUS # OF DEPENDENTS         AGES
         
HOME ADDRESS
*  
CITY                                                        STATE                                        ZIP
* ,*   *
YEARS AT PRESENT ADDRESS CURRENT RESIDENTIAL STATUS
*   *
PRESENT EMPLOYER NAME SELF EMPLOYED
*    2 YEARS TAX RETURNS REQUIRED
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.  Are you a co-maker or endorser on a note?
     Explanation        
i.  Citizenship?
APPLICANT #2
FULL NAME (First Middle Last) SOCIAL SECURITY #                        MEMBER NUMBER
 
     
WORK PHONE #                                                      HOME PHONE #   EMAIL ADDRESS
                               
DATE OF BIRTH
MARITAL STATUS # OF DEPENDENTS     AGES
   
HOME ADDRESS
CITY                                                STATE                                     ZIP
,
YEARS AT PRESENT ADDRESS CURRENT RESIDENTIAL STATUS
     
PRESENT EMPLOYER NAME SELF EMPLOYED
   2 YEARS TAX RETURNS REQUIRED
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.  Are you a co-maker or endorser on a note?
     Explanation        
i.  Citizenship?
LOAN/PROPERTY INFORMATION 
*PURPOSE OF LOAN
     PLEASE DESCRIBE   
IF AUTO IS SELECTED, PLEASE COMPLETE THE FOLLOWING.
YEAR, MAKE MODEL & VIN
LOAN AMOUNT REQUESTED
*
TERM REQUESTED
 months
PAYMENT TERMS
 PRESENT MONTHLY HOUSING
 RENT
 
FIRST MORTGAGE
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 spouse or other person, this Statement and supporting schedules must be completed about that spouse or other person also.

LIABILITY TYPE
CREDITOR
 CURRENT BALANCE MONTHLY PAYMENT
LIABILITY TYPE
CREDITOR
 CURRENT BALANCE MONTHLY PAYMENT
LIABILITY TYPE
CREDITOR
 CURRENT BALANCE MONTHLY PAYMENT
LIABILITY TYPE
CREDITOR
 CURRENT BALANCE MONTHLY PAYMENT
LIABILITY TYPE
CREDITOR
 CURRENT BALANCE MONTHLY PAYMENT
LIABILITY TYPE
CREDITOR
 CURRENT BALANCE MONTHLY PAYMENT
LIABILITY TYPE
CREDITOR
 CURRENT BALANCE MONTHLY PAYMENT
LIABILITY TYPE
CREDITOR
 CURRENT BALANCE MONTHLY PAYMENT
1. BORROWER REFERENCE
NAME (First Middle Last)
*    *
ADDRESS
*
CITY                                                STATE                                     ZIP
* ,   *   *
PHONE NUMBER
*
RELATIONSHIP
*
2. BORROWER REFERENCE
NAME (First Middle Last)
   
ADDRESS
CITY                                                STATE                                     ZIP
,    
PHONE NUMBER
3. BORROWER REFERENCE
NAME (First Middle Last)
   
ADDRESS
CITY                                                STATE                                     ZIP
,    
PHONE NUMBER

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.