Who is your Mortgage Officer? (If none, leave blank):

What type of mortgage are you applying for? Conventional (Standard) VA Loan (Veterans) FHA (Government Loan) USDA/Rural Housing Service (Not Common)          Desired Loan Amount? $ 

Desired Interest Rate?   How many years would you like the loan for?yrs 

Amortization Type? Fixed Rate Adjustable Rate GPM Other   If adjustable, how long would you like the rate fixed for? NONE 1 Year or Less 2 Years 3 Year 5 Year 10 Years +

II. Property Information and Purpose of loan

Location of property we are loaning the money on?

City:    State:      Zip:    Number of Units? 1 2 3 4+     Year Built?

Purpose of the loan? Purchase Refinance/No Cash Out Refinance/Cash Out Construction Construction- Permenant Other     Property will be? Primary Residence Secondary Residence Investment

Complete this line if Construction, or Construction-Permanent Loan.

Year Lot Acquired?     Original cost?  $     Amount Existing Liens? $ 

(a) Present Value of Lot? $    (b) Cost of Improvements? $     Total (a+b) $

Complete this line if this is a refinance loan.

Year Property Acquired?     Original cost?  $     Amount Existing Liens? $ 

Purpose of Refinance? (example: debt consolidation, home improvements, tuition, etc.)

Describe Improvements if any?

Cost $    made     to be made

Title will be held in what name/s?    

Title will be held in what manner? Joint Tenants Single Man Single Woman Tenants in Common To be determined in escrow

III. Borrower Information

Borrower's Full Name (Include Jr. or Sr. if applicable)     Email Address:     

Social Security Number:           Home Phone:           DOB:       Yrs. School:           Marital Status:  Married Unmarried(single, divorced, widowed) Separated

Number of Dependents (not listed by co-borrower):           Ages:    (example: 4, 12, 14, etc.)

Borrower's Address (if same as collateral, type "SAME"):

City:    State:      Zip:    Own: or, Rent:   How many Years?      (example: 1yr 6mnts equals 1.5)

Mailing address same as above?    

If residing at address less than 2 years, complete the following:

1.)

City:    State:      Zip:     Own: or, Rent: Move in Date:      

2.)

City:    State:      Zip:     Own: or, Rent: Move in Date:       

Co-Borrower:

Full Name (Include Jr. or Sr. if applicable)    

Email Address:

Social Security Number:     000-00-0000    Home Phone:           DOB:       Yrs. School:          

Marital Status:  Married Unmarried(single, divorced, widowed) Separated Number of Dependents (not listed by borrower):          

Ages: (example: 4, 12, 14, etc.)

Resident History Same as Borrower: (If Yes, check and scroll to bottom of this page)

Co-Borrower's Address (if same as collateral, type "SAME"):

City:    State:      Zip:    Own: or, Rent:   How many Years?      (example: 1yr 6mnts equals 1.5)

Mailing address same as above?    

If residing at address less than 2 years, complete the following:

1.)

City:    State:      Zip:     Own: or, Rent: No. Years?     

2.)

City:    State:      Zip:     Own: or, Rent: No. Years?     

I/We the Borrower/Co-Borrower state that the above information is accurate according to the best of our knowledge:   

Borrower Initials:          Co-Borrower Initials: