Mortgage Application

PERSONAL LOAN / VISA APPLICATION

APPLICANT #1 * indicates required fields
FULL NAME (First Middle Last)	SOCIAL SECURITY # MEMBER NUMBER
* * First Name is requiredLast Name is required	* Social Security Number is required
WORK PHONE # HOME PHONE #	EMAIL ADDRESS
* Work Phone is required * Home Phone is required	* Email Address is required
DATE OF BIRTH
* Date of Birth is required
MARITAL STATUS	# OF DEPENDENTS AGES

HOME ADDRESS
* Current address required
CITY STATE ZIP
* Current city required,* Current state required* Current zip required
YEARS AT PRESENT ADDRESS	CURRENT RESIDENTIAL STATUS
* Years at Present Address is required	* Current Residential Status is required

PREVIOUS ADDRESS (If less than 2 years at present address)

CITY STATE ZIP
,
PREVIOUS RESIDENTIAL STATUS	YEARS AT PREVIOUS ADDRESS

PRESENT EMPLOYER NAME	SELF EMPLOYED
* Present Employer Name is required	YES 2 YEARS TAX RETURNS REQUIRED
TYPE OF BUSINESS	YEARS IN THIS TYPE OF WORK

EMPLOYER ADDRESS
* Present Employer Address is required
CITY STATE ZIP
* Present Employer City is required , * Present Employer State is required * Present Employer Zip Code is required
POSITION/TITLE	YEARS IN THIS POSITION
	* Years in this Position is required
PHONE NUMBER
* Employer Phone is required
GROSS MONTHLY SALARY
* Gross Monthly Salary is required

PREVIOUS EMPLOYER (If less than 2 years with present employer)	SELF EMPLOYED
	YES 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?

YES

N/A

Explanation

b. Have you been declared bankrupt within the past seven years?

YES

N/A

Explanation

c. Have you had property foreclosed upon or given title or deed in lieu thereof in the last seven years?

YES

N/A

Explanation

d. Are you a party to a lawsuit?

YES

N/A

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.

YES

N/A

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.

YES

N/A

Explanation

g. Are you obligated to pay alimony, child support or separate maintenance?

YES

N/A

Explanation

h. Are you a co-maker or endorser on a note?

YES

N/A

Explanation

i. Citizenship?

APPLICANT #2
WE INTEND TO APPLY FOR JOINT CREDIT

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

PREVIOUS ADDRESS (If less than 2 years at present address)

CITY STATE ZIP
,
PREVIOUS RESIDENTIAL STATUS	YEARS AT PREVIOUS ADDRESS

PRESENT EMPLOYER NAME	SELF EMPLOYED
	YES 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

PREVIOUS EMPLOYER (If less than 2 years with present employer)	SELF EMPLOYED
	YES 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?

YES

N/A

Explanation

b. Have you been declared bankrupt within the past seven years?

YES

N/A

Explanation

c. Have you had property foreclosed upon or given title or deed in lieu thereof in the last seven years?

YES

N/A

Explanation

d. Are you a party to a lawsuit?

YES

N/A

Explanation

YES

N/A

Explanation

YES

N/A

Explanation

g. Are you obligated to pay alimony, child support or separate maintenance?

YES

N/A

Explanation

h. Are you a co-maker or endorser on a note?

YES

N/A

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

Biweekly

Semi-monthly

Monthly

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.