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Please fill out the following information and click the 'Submit' button at the end of the application.

UNIFORM RESIDENTIAL LOAN APPLICATION

This application is designed to be completed by the applicant(s) with the lender's assistance.  Applicants should complete this form as "Borrower" or "Co-Borrower", as applicable.  Co-Borrower information must also be provided (and the appropriate box checked) when the income of assets of a person other than the "Borrower" (including the Borrower's spouse) will be used as a basis for loan qualification or the income or assets of the Borrower's spouse will not be used as a basis for loan qualification, but his or her liabilities must be considered because the Borrower resides in a community property state, or the Borrower is relying on other property located in a community property state as a basis for repayment of the loan.

I.  TYPE OF MORTGAGE AND TERMS OF LOAN

Mortgage Applied for:    
VA  Conventional Other
FHA FmHA
Amount:    Interest Rate:          
Number of Months:   
Amortization Type:    
Fixed Rate  Other (explain): 
GPM ARM (type):      

II.  PROPERTY INFORMATION AND PURPOSE OF LOAN
Subject Property Address:   City:      
State: Zip Code:
Number of Units: 
Purpose of Loan:    
Purchase  Construction
Refinance Construction-Permanent
Other (explain): 
Property will be:    
Primary Residence
Secondary Residence
Investment
Complete the following 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 the following if this is a refinance loan.
Year Acquired:   Original Cost:  $
Amount Existing Liens:  $
Purpose of Refinance: 
Describe Improvements:  Made:
To Be Made:
     Cost:  $
Title will be held in what name?: 
Manner in which Title will be held: 
Estate will be held in:    
Fee Simple
Leasehold
    (show expiration date)
Source of Down Payment, Settlement Charges and / or Subordinate Financing (explain): 

III.  BORROWER INFORMATION
Borrower
Borrower's Name: 
(include Jr. or Sr. if applicable)
Social Security Number:
Home Phone:
(include area code)
Date of Birth:  Years of School:
Marital Status: Married
 Separated
 Unmarried (include single, divorced, widowed
Dependents:
(not listed by co-borrower)		 Number:  
Ages:  
Present Address:
 own
rent
Number of years:
Street or PO Box:  
City:  
State:
Zip Code:
If residing at present address for less than two years, complete the following:
Former Address:
 own
rent
Number of years: 		Street or PO Box:  
City:  
State:
Zip Code:
Former Address:
 own
rent
Number of years: 		Street or PO Box:  
City:  
State:
Zip Code:
Co-Borrower
Co-Borrower's Name: 
(include Jr. or Sr. if applicable)
Social Security Number:
Home Phone:
(include area code)
Date of Birth:  Years of School:
Marital Status: Married
 Separated
 Unmarried (include single, divorced, widowed
Dependents:
(not listed by borrower)		 Number:  
Ages:  
Present Address:
 own
rent
Number of years:
Street or PO Box:  
City:  
State:
Zip Code:
If residing at present address for less than two years, complete the following:
Former Address:
 own
rent
Number of years: 		Street or PO Box:  
City:  
State:
Zip Code:
Former Address:
 own
rent
Number of years: 		Street or PO Box:  
City:  
State:
Zip Code:

IV.  EMPLOYMENT INFORMATION
Borrower
Self-Employed:
Employer Name:
Employer Address:
Years on this Job:
Years employed in this line of work / profession:
Position:
Title:
Type of Business:
Business Phone:
(include area code)
If employed in current position for less than two years or if currently employed in more than one position, complete the following:
Self-Employed:
Employer Name:
Employer Address:
Dates (from - to):
Monthly Income: $
Position:
Title:
Type of Business:
Business Phone:
(include area code)
Self-Employed:
Employer Name:
Employer Address:
Dates (from - to):
Monthly Income: $
Position:
Title:
Type of Business:
Business Phone:
(include area code)
Co-Borrower
Self-Employed:
Employer Name:
Employer Address:
Years on this Job:
Years employed in this line of work / profession:
Position:
Title:
Type of Business:
Business Phone:
(include area code)
If employed in current position for less than two years or if currently employed in more than one position, complete the following:
Self-Employed:
Employer Name:
Employer Address:
Dates (from - to):
Monthly Income: $
Position:
Title:
Type of Business:
Business Phone:
(include area code)
Self-Employed:
Employer Name:
Employer Address:
Dates (from - to):
Monthly Income: $
Position:
Title:
Type of Business:
Business Phone:
(include area code)

V.  MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION

Gross Monthly Income Borrower Co-Borrower Total
Base Empl. Income*: $ $ $
Overtime: $ $ $
Bonuses: $ $ $
Commissions: $ $ $
Dividends / Interest: $ $ $
Net Rental Income: $ $ $
Other: (before completing, see the notice in "describe other income" below) $ $ $
Total: $ $ $
Combined Monthly Housing Expense Present Proposed
Rent: $ $
First Mortgage (P&I): $ $
Other Financing (P&I): $ $
Hazard Insurance: $ $
Real Estate Taxes: $ $
Mortgage Insurance: $ $
Homeowner Assn. Dues: $ $
Other: $ $
Total: $ $
*Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.
Describe Other Income:
(Notice:  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.)
Borrower:

Monthly Amount:  $

Co-Borrower:

Monthly Amount: $

VI.  ASSETS AND 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, this Statement and supporting schedules must be completed about that spouse also.

Completed:         Jointly      Not Jointly
ASSETS
List checking and savings accounts below
Name of Bank, SYL, or Credit Union:
Address of Bank, SYL, or Credit Union:
Account Number:
Cash or Market Value: $
Name of Bank, SYL, or Credit Union:
Address of Bank, SYL, or Credit Union:
Account Number:
Cash or Market Value: $
Name of Bank, SYL, or Credit Union:
Address of Bank, SYL, or Credit Union:
Account Number:
Cash or Market Value: $
Name of Bank, SYL, or Credit Union:
Address of Bank, SYL, or Credit Union:
Account Number:
Cash or Market Value: $
Stocks & Bonds
Company Name:
Account Number:
Description:
Cash or Market Value:
Life Insurance
Net Cash Value: $
Face Amount: $
Subtotal Liquid Assets: $
Real Estate Owned:
(enter market value from schedule of real estate owned)		 $
Vested interest in retirement fund: $
Net worth of business(es) owned:
(attach financial statement)		 $
Automobiles Owned:
Make:
 Year:
 Cash or Market Value:
$
Make:
 Year:
 Cash or Market Value:
$
Make:
 Year:
 Cash or Market Value:
$
Other Assets (itemize): Cash or Market Value:
Item #1: $
Item#2: $
Item#3:
 $
Total Assets a: $
LIABILITIES AND PLEDGED ASSETS  List the creditor's name, address and account number for all outstanding debts, including automobile loans, revolving charge accounts, real estate loans, alimony, child support, stock pledges, etc.  Use continuation sheet if necessary.  Indicate by (*) those liabili