Purpose:	Purchase  Refinance
Type:	Fixed  Adjustable
Term:	15 Year  20 Year  30 Year  Other
Property type:	1 Family  2, 3, 4 Family  Condo  Co-op  Mixed-Use  Commercial

Property Information
Subject Property Address:
Street:
City:
State:	Zip:
Country:

Property will be:

Primary Residence  Secondary Residence  Investment

Complete if this is a refinance loan:

Year Acquired:
Original Cost:	$
Amount Existing Liens:	$
Purpose of Refinance:

Title will be held in what name(s):

Source of funds for down payment and/or closing costs:

Borrower Information		Co-Borrower Information
Name of Borrower:		Name of Co-Borrower:
Home Phone:	(include area/country codes)	Co-Borrower Tel:	(include area/country codes)
Social Security No.:		Social Security No.:
Age:		Age:
Married  Separated  Unmarried/Widowed		Married  Separated  Unmarried/Widowed
Present Address:		Present Address:
Street:		Street:
City:		City:
State:	Zip:	State:	Zip:
Country:		Country:
	Own  Rent		Own  Rent
How Long:		How Long:

Borrower Employment Information		Co-Borrower Employment Information
Name of Employer:		Name of Employer:
Employer Address:		Employer Address:
Street:		Street:
City:		City:
State:	Zip:	State:	Zip:
Country:		Country:
Years on Job:		Years on Job:
Years in this profession:		Years in this profession:
Position/Title:		Position/Title:
Business Phone:	(include area/country codes)	Business Phone:	(include area/country codes)

Borrower Income Information		Co-Borrower Income Information
Gross Monthly Income:	$	Gross Monthly Income:	$
From salary, rental income, bonuses, dividends, etc.)		From salary, rental income, bonuses, dividends, etc.)

Borrower Monthly Housing Expenses		Co-Borrower Monthly Housing Expenses
Current Monthly Rent:	$	Current Monthly Rent:	$
Mortgage Payment:	$	Mortgage Payment:	$
Real Estate Taxes and Ins.:	$	Real Estate Taxes and Ins.:	$

Borrower Asset Information		Co-Borrower Asset Information
Borrower Asset Description		Co-Borrower Asset Description
List Names of Banks		List Names of Banks
Bank Name:		Bank Name:
Bank Address:		Bank Address:
Street:		Street:
City:		City:
State:	Zip:	State:	Zip:
Country:		Country:
Account Number:		Account Number:
Average Account Balance:	$	Average Account Balance:	$
Bank Name:		Bank Name:
Bank Address:		Bank Address:
Street:		Street:
City:		City:
State:	Zip:	State:	Zip:
Country:		Country:
Account Number:		Account Number:
Average Account Balance:	$	Average Account Balance:	$
Stocks and Bonds		Stocks and Bonds
Company Name	Account No.	Company Name	Account No.

Borrower Liabilities		Co-Borrower Liabilities
Creditor Name:		Bank Name:
Monthly Payment:	$	Monthly Payment:	$
Balance Owed:	$	Balance Owed:	$
Creditor Name:		Bank Name:
Monthly Payment:	$	Monthly Payment:	$
Balance Owed:	$	Balance Owed:	$
Creditor Name:		Bank Name:
Monthly Payment:	$	Monthly Payment:	$
Balance Owed:	$	Balance Owed:	$
Creditor Name:		Bank Name:
Monthly Payment:	$	Monthly Payment:	$
Balance Owed:	$	Balance Owed:	$

Schedule of Real Estate Owned
Property Address Owned:
Street:
City:
State:	Zip:
Country:
Type of Property:	Single Family  2, 3, 4 Unit  Condo
Present Value:	$
Amount of Mortgage:	$
Mortgage Payment:	$
Insurance:	$
Rental Income Per Month (if applicable>:	$
Real Estate Taxes Per Month:	$

Acknowledgment and Agreement

The undersigned acknowledges and agrees that (1) loan requested by the application will be secured by a first mortgage or deed of trust on tbat property described; (2) the property will not be used for any illegal purposes or uses (3) all statements made in tbis application are made for purposes of obtaining loan indicated herein; (4) occupation of property will be indicated as above; (5) verification or reverification of any information contained in the application may be made at any time by the Lender it's agents and or assigns, eitber directly through a credit reporting agency, or from any source named within this application and the original application shall be held by the lender, even if loan is not approved; (6) the Lender, its agents successors and or assigns will rely upon information contained in this application and I /we have a continuing OBLIGATION TO amend and/ or supplement information provided in application if any of the material facts which I /we have represented herein should change prior to closing; (7) in the event my/our payments on the loan indicated in this application become delinquent, the Lender, it's agents, successors, and /or assigns, may, in addition to all of their other rights and remedies, report my/our name(s) and account information to a credit reporting agency; (8) ownership of the loan may be trans*rred to an agent, successor or assign of the Lender without notice to me and/or the administration of the loan account may be transferred to an agent, successor and/or assign of the Lender with prior notice to me; (9) the Lender, it's agents, successors and/or assigns make no representations or warranties, express or implied, to the Borrower(s) regarding the property, condition of the property, or value of the property; (10) consumer credit reports will be obtained in connection with this application & we will inform you of the names and addresses of the agency(ies) supplying the report(s). CERTIFICATION: I/We certify that the information provided in this application is true and correct as of the date set forth opposite my/our signature(s) on this application & acknowledge my/our understanding that any intentional negligent misrepresentation(s) of the information contained in this application may result in civil liability for monetary damages to the Lender, it's agents, successors and/or assigns, insurers and any other person(s) who may suffer any loss due to reliance upon any misrepresentation which I/We have made on this application.

Borrower's Name:
Date:
Co-Borrower's Name:
Date: