Step 1 of 7

Property Information

Primary ResidenceSecondary HomeInvestment Property

Loan Information

Borrower Information

Borrower
Borrower's Name(Required)
Date of Birth
Month123456789101112
Day12345678910111213141516171819202122232425262728293031
Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920
Marital Status
Co-Borrower's Name
Date of Birth
Month123456789101112
Day12345678910111213141516171819202122232425262728293031
Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920
Marital Status

Borrower Information cont.

Present Address
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Type
12345678910+

Borrower Present Employer Information

Self-Employed?
012345678910+
0123456789101112
012345678910+
0123456789101112

Co-Borrower Present Employer Information

Self-Employed?
012345678910+
0123456789101112
012345678910+
0123456789101112

Borrower Income

Do You Rent or Own Your Current House?

Co-Borrower Income

Do You Rent or Own Your Current House?

Declarations

Are there any outstanding judgments against you?
Have you been declared bankrupt within the past 7 years?
Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?
Are you a party to a lawsuit?
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.)
Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation bond, or loan guarantee?
Are you obligated to pay alimony, child support, or separate maintenance?
Is any part of the down payment borrowed?
Are you a co-maker or endorser on a note?
Are you a U.S. citizen?
Are you a permanent resident alien?
Do you intend to occupy the property as your primary residence?
Have you had ownership interest in a property in the last three years? If "Yes," complete question m.1 and m.2 below.
PRSHIP
SSPO

Co-Borrower Declarations

Are there any outstanding judgments against you?
Have you been declared bankrupt within the past 7 years?
Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?
Are you a party to a lawsuit?
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.)
Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation bond, or loan guarantee?
Are you obligated to pay alimony, child support, or separate maintenance?
Is any part of the down payment borrowed?
Are you a co-maker or endorser on a note?
Are you a U.S. citizen?
Are you a permanent resident alien?
Do you intend to occupy the property as your primary residence?
Have you had ownership interest in a property in the last three years? If "Yes," complete question m.1 and m.2 below.
PRSHIP
SSPO

Contact Information

8:00am9:00am10:00am11:00amnoon1:00pm2:00pm3:00pm4:00pm5:00pm
MondayTuesdayWednesdayThursdayFriday

Acknowledgement and Agreement

By checking a radio button below, you attest that the information provided is true and accurate.
The information I have provided is true and accurate.(Required)

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 neither discriminate on the basis of this information, nor whether you choose to furnish it. However, if you choose not to furnish it, under Federal regulations this Lender is required to note race and sex on the basis of visual observation or surname. If you do not wish to furnish the above information, please check the box below. (Lender must review the above material to assure that the disclosure satisfies all requirements to which the Lender is subject under applicable state law for the particular type of loan applied for.)
I do not wish to furnish this informationAmerican Indian or Alaskan NativeAsian or Pacific IslanderBlack, not of Hispanic originHispanicWhite, not of Hispanic OriginOther
I do not wish to furnish this informationMaleFemale
I do not wish to furnish this informationAmerican Indian or Alaskan NativeAsian or Pacific IslanderBlack, not of Hispanic originHispanicWhite, not of Hispanic OriginOther
I do not wish to furnish this informationMaleFemale
RadioTVRealtorFriendOther
This field is for validation purposes and should be left unchanged.

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