Mortgage Loan Application Form

HomeMortgage Loan Application Form

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.

* - Indicates required fields

Loan Information

Is there a lender assisting you with this application? *

Are you applying for joint credit? If yes is checked, this is an Application for Joint Credit. By signing below, the Applicant and Co-Applicant agree that each of us intend to apply for joint credit. (Complete Applicant and Co-Applicant sections.) * Yes No

What type of mortgage are you applying for? * Conventional USDA/Rural Housing Service Other

Explain *

Purpose of Loan * Purchase Refinance Construction

Total Loan Amount *

Purchase Price *

Is this an application for pre-qualification? * Yes No

Property Information

Property Address *

City *

State *

Zip Code *

Number of Units *

REFINANCE

Year Acquired *

Original Cost *

Amount of Existing Liens *

Purpose of Refinance *

Will this be used for improvements? * Yes No

Improvements have already been made.

Describe Improvements *

Borrower Information

First Name *

Middle Initial

Last Name *

Suffix

Social Security Number *

Birth Date *

Primary Phone Number *

E-mail Address *

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? * Yes No

Previous Home Address *

City *

State *

Zip Code *

Did you own or rent this property? * Own Rent Other

Explain *

Residency Start Date *

Monthly Mortgage Payment *

Marital Status * Married Unmarried (single, divorced, widowed) Separated

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? * Yes No

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 *

Primary Phone Number *

E-mail Address *

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 Payment

Have you lived here for two or more years? * Yes No

Previous Home Address *

City *

State *

Zip Code *

Did you own or rent this property? * Own Rent Other

Explain *

Residency Start Date *

Monthly Mortgage Payment *

Marital Status * Married Unmarried (single, divorced, widowed) Separated

Number of Dependents (Not Listed by 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? * Yes No

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

Real Estate

Second Home/Investment Property

Property Address

City

State

Zip Code

Estimated Value

Other Assets

Description

Total Value

Current Monthly Payments (Liabilities)

Name of Company

Monthly Payment

Declarations

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? * Yes No

Are you a permanent resident alien? * Yes No

Explain *

Do you intend to occupy the property as your primary residence? * Yes No

Have you had an ownership interest in a property in the last three years? * Yes No

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 *

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? * Yes No

Are you a permanent resident alien? * Yes No

Explain *

Do you intend to occupy the property as your primary residence? * Yes No

Have you had an ownership interest in a property in the last three years? * Yes No

Information for Government Monitoring Purposes

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 discriminate neither on the basis of this information, nor on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, this lender is required to note the information on the basis of visual observation or surname. If you do not wish to furnish that information, please check the box below. (Lender must review the above material to assure that he disclosures satisfy all requirements to which the lender is subject under applicable state law for the particular type of loan applied for.)

Borrower

Ethnicity *

Specify Other Hispanic or Latino Origin

Race *

Specify Other Asian Origin

Specify Other Pacific Islander Origin

Sex *

I do not wish to participate

Co-Borrower

Ethnicity *

Specify Other Hispanic or Latino Origin

Race *

Specify Other Asian Origin

Specify Other Pacific Islander Origin

Sex *

I do not wish to participate

Acknowledgement & 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.

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.

Faith Hollasch NMLSR #779584

NMLSR #758359

To find a Housing Counselor, please visit the Consumer Financial Protection Bureau to locate the counselors nearest you.

Please check here that you have visited the Consumer Financial Protection Bureau website. (You must read the document to enable this checkbox.) *

Click here to review the Consumer Financial Protection Bureau "Your Home Loan Toolkit".

Notice to the Home Loan Applicant

In connection with your application for a home loan, the lender must disclose to you the score that a consumer-reporting agency distributed to users and the lender used in connection with your home, and the key factors affecting your credit scores.

The credit score is a computer-generated summary calculated at the time of the request and based on the information that a consumer reporting agency or lender has on file. The scores are based on data about your credit history and payment patterns. Credit scores are important because they are used to assist the lender in determining whether you will obtain a loan. They may also be used to determine what interest rate you may be offered on the mortgage. Credit scores can change over time depending on your conduct, how your credit history and payment patterns change, and how credit-scoring technologies change.

Because the score is based on information in your credit history, it is very important that you review the credit-related information that is being furnished to make sure it is accurate. Credit scores may vary from one company to another.

If you have questions about your credit score or the credit information that is furnished to you, contact the consumer reporting agency at the address and telephone number provided with this notice or contact the lender. If the lender developed or generated the credit score. The consumer reporting agency plays no part in the decision to take any action on the loan application and is unable to provide with specific reasons for the decision on a loan application.

Equifax 800-685-1111
P.O. Box 740256
Atlanta, GA 30374

Appraisal Notification

We may order an appraisal to determine the property's value and charge you for this appraisal. We will promptly give you a copy of any appraisal, even if your loan does not close. you can pay for an additional appraisal for your own use at your own cost.

Borrower's Signature *

Date

Co-Borrower's Signature *

Date