I. TYPE OF MORTGATE AND TERMS OF LOAN
Mortgage Applied for : VA FHA Conventional USDA/Rural Housing Service Other(Explain)
Agency Case Number : Lender Case Number :
Amount : Interest Rate :
No. of Months : Amortization Type : Fixed Rate GPM ARM Other
II. PROPERTY INFORMATION AND PURPOSE OF LOAN
Subject Property Address(Street, City, State, &ZIP) : *
No. of Units : Year Built:
Legal Description of Subject Property :
Purpose of Loan : Purchase Refinance Construction Construction Payment Other(Explain)
Property will be : Primary Residence Second Residence Investment
Complete this block if Construction or Construction-Payment Loan
Year Lot Acquired : Original Cost : Amount Existing Liens :
(a)Present Value of Lot : (b)Cost of Improvement : Total(a+b) :
Complete this block if this is a refinance Loan
Year Lot Acquired : Original Cost : Amount Existing Liens :
Purpose of Refinancet : Describe Improvements : Made To be made Cost($) :
Title will be held in what Name(s) : Manner in which Title will be held :
Source of Down Payment, Settlement Charges and/or Subordinate Financing(explain): Estate will be held in : Free Simple LeaseHold
III. BORROWER INFORMATION
Borrower Co-Borrower
Borrower's Name (Include Jr. or Sr. if applicable) : *
Social Security Number : - - *
Home Phone : Email :
DOB(MM/DD/YYYY) : Yrs.School :
Married Separated Unmarried (include single, divorced, widowed)
Dependents (not listed by Co-Borrower) : No. Ages
Present Address :

City : State :
Zip : Own Rent No.Yrs
Mailing Address, if different from Present Address : City : State :
Zip :  
If residing at present address for less than two years, complete the following :
Former Address :

City : State :
Zip : Own Rent No.Yrs
Former Address :

City : State :
Zip : Own Rent No.Yrs
Borrower's Name (Include Jr. or Sr. if applicable) :
Social Security Number : - -
Home Phone : Email :
DOB(MM/DD/YYYY) : Yrs.School :
Married Separated Unmarried (include single, divorced, widowed)
Dependents (not listed by Co-Borrower) : No. Ages
Present Address :

City : State :
Zip : Own Rent No.Yrs
Mailing Address, if different from Present Address : City : State :
Zip :  
If residing at present address for less than two years, complete the following :
Former Address :

City : State :
Zip : Own Rent No.Yrs
Former Address :

City : State :
Zip : Own Rent No.Yrs
IV. EMPLOYMENT INFORMATION
Borrower Co-Borrower
Employer : Self Employed Name :
Address :

City : State :
Zip :  
Dates : - Monthly Income$ :
Position/Title/Type of Business : Business Phone (incl,area code) :
If employed in current position for less than two years or if currently employed in more than one position, complete the following :
Employer : Self Employed Name :
Address :

City : State :
Zip :  
Dates : - Monthly Income$ :
Position/Title/Type of Business : Business Phone (incl,area code) :
Employer : Self Employed Name :
Address :

City : State :
Zip :  
Dates : - Monthly Income$ :
Position/Title/Type of Business : Business Phone (incl,area code) :
Employer : Self Employed Name :
Address :

City : State :
Zip :  
Dates : - Monthly Income$ :
Position/Title/Type of Business : Business Phone (incl,area code) :
Employer : Self Employed Name :
Address :

City : State :
Zip :  
Dates : - Monthly Income$ :
Position/Title/Type of Business : Business Phone (incl,area code) :
Employer : Self Employed Name :
Address :

City : State :
Zip :  
Dates : - Monthly Income$ :
Position/Title/Type of Business : Business Phone (incl,area code) :
If employed in current position for less than two years or if currently employed in more than one position, complete the following :
Employer : Self Employed Name :
Address :

City : State :
Zip :  
Dates : - Monthly Income$ :
Position/Title/Type of Business : Business Phone (incl,area code) :
Employer : Self Employed Name :
Address :

City : State :
Zip :  
Dates : - Monthly Income$ :
Position/Title/Type of Business : Business Phone (incl,area code) :
Employer : Self Employed Name :
Address :

City : State :
Zip :  
Dates : - Monthly Income$ :
Position/Title/Type of Business : Business Phone (incl,area code) :
Employer : Self Employed Name :
Address :

City : State :
Zip :  
Dates : - Monthly Income$ :
Position/Title/Type of Business : Business Phone (incl,area code) :
V. MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION
Gross Monthly Income Borrower Co-Borrower Total Combined Monthly Housing Expense Present Proposed
Base Empl. Income Rent
Overtime First Mortgate(P&J)
Bonuses Other Financing(P&J)
Commissions Hazard Insurance
Dividends/Interest Real Estate Taxes
Net Rental Income Mortgage Insurance
Other Other
Total Total
VI. ASSETS AND LIABILITIES
Assets (Description) Cash or Market Value
Cash deposit purchase held by $
Automobiles (make and year) $
Schedule of Real Estate Owned

Property Address(if additional properties are owned, use continuation sheet)
Propert Address (enter S if sold, PS if peding sale or R if rental being held for income

Type of Property Present Market Value Amount of Mortgages & Liens Gross Rental Income Mortgage Payments Insurance, Maintenance, Taxes & Misc. Net Rental Income
Address
City, State, Zip
S PS R $ $ $ $ $ $
Address
City, State, Zip
S PS R $ $ $ $ $ $
Address
City, State, Zip
S PS R $ $ $ $ $ $
  Total $ $ $ $ $ $
VII. DECLARATIONS
  Borrower Co-Borrower
Yes No Yes No
a.Are there any outstanding judgments against you?
b.Have you been declared bankrupt within the past 7 years?
c.Have you had propety foreclosed upon or give title or deed in lieu thereof in the last 7 years?
d.Are you a party to a lawsuit?
e.Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment?
f.Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee?
g.Are you obligated to pay alimony, child support, ot separate maintenance?
h.Is any part of the down payment borrowed?
i.Are you a co-maker or endorser on a note?
j.Are you a U.S. citizen?
k.Are you a permanent resident alien?
l.Do you intend to occupy the property as your primary residence?
m.Have you had an ownership interest in a property in the past 3 years?
(1)What type of property did you own-principal residence (PR),second home(SH), or investment property (IP)?
(2)How did you hold title to the home-solely by yourself (S), jointly with your spouse(SP),or jointly with another person(O)?
Borrower: I don't wish to funish the following information Co-Borrower I don't wish to funish the following information
Ethnicity: Hispanic or Latino Ethnicity: Hispanic or Latino

Race:
American Indian or Alaska Asian
Black or African American White
Native Hawaiian or other Pacific Islander

Race:
American Indian or Alaska Asian
Black or African American White
Native Hawaiian or other Pacific Islander
Sex: Female Male Sex: Female Male
Please select an agent: