NorthSide Mortgage Group, LLC.
NMLS 68411
Referring Loan Officer
Please Select
Carmen Smith
Macy Smith Swartz
Stan Smith
Kevin Weatherman
I have not spoken to a Loan Officer prior to completing this application.
Are you interested in purchasing or refinancing?
Purchasing
Refinancing
For Refinance only-
15 Year
20 Year
30 Year
Cash Out
No Cash Out
If purchase, is there a maximum monthly payment you do not want to exceed?
Enter payment amount above if applicable.
Do you own any other property? If so, please list any addresses below.
Do you owe any money to the IRS? If so, how much?
List amount owed above if applicable.
Borrower
Name shown on Social Security Card
Social Security Number
Date of Birth
Cell Phone Number
Email Address
Preferred method of contact (Text, Email, etc.)
Current Address (Include City/St/Zip)
Amount of time resided at current address
Current Address
Please Select
Own
Rent
No Housing Expenses
Monthly Payment
Previous Address (ONLY IF YOU HAVE NOT LIVED AT YOUR CURRENT ADDRESS FOR AT LEAST 2 YEARS) - Include City/St/Zip
Amount of time resided at previous address
Previous Address
Please Select
Own
Rent
No Housing Expenses
Monthly Payment
Marriage Status
Please Select
Single
Married
Unmarried
Separated
Dependents and Ages
Citizenship
Total number of years in school
Employer
Employer Phone Number
Employer Address
Start Date (MM/DD/YYYY)
Position/Title
Weekly Income (Before Taxes)
Weekly Hours
Are you self employed?
Please Select
Yes
No
Do you pay or receive child support?
Please Select
Yes
No
Do you receive Social Security payments?
Please Select
Yes
No
Do you receive any other income?
Please Select
Yes
No
If you have not been employed TWO YEARS or longer at your current job, please complete the below.
Previous Employer
Employer Phone Number
Employer Address
Start Date (MM/DD/YYYY)
End Date (MM/DD/YYYY)
Position/Title
Weekly Income (Before Taxes)
Were you self employed?
Please Select
Yes
No
Co-Borrower
Name shown on Social Security Card
Social Security Number
Date of Birth
Cell Phone Number
Email Address
Preferred method of contact (Text, Email, etc.)
Current Address (Include City/St/Zip)
Amount of time resided at current address
Current Address
Please Select
Own
Rent
No Housing Expense
Monthly Payment
Previous Address (ONLY IF YOU HAVE NOT LIVED AT YOUR CURRENT ADDRESS FOR AT LEAST 2 YEARS) - Include City/St/Zip
Amount of time resided at previous address
Previous Address
Please Select
Own
Rent
No Housing Expense
Monthly Payment
Marriage Status
Please Select
Single
Married
Unmarried
Separated
Dependents and Ages
Citizenship
Total number of years in school
Employer
Employer Phone Number
Employer Address
Start Date (MM/DD/YYYY)
Position/Title
Weekly Income (Before Taxes)
Weekly Hours
Are you self employed?
Please Select
Yes
No
Do you pay or receive child support?
Please Select
Yes
No
Do you receive Social Security payments?
Please Select
Yes
No
Do you receive any other income?
Please Select
Yes
No
If you have not been employed TWO YEARS or longer at your current job, please complete the below.
Employer
Employer Phone Number
Type a question
Employer Address
Start Date (MM/DD/YYYY)
End Date (MM/DD/YYYY)
Position/Title
Weekly Income (Before Taxes)
Were you self employed?
Please Select
Yes
No
Bank Information
Please include all accounts.
Bank Name
Type of Account (Checking, Savings, etc.)
Average Balance ($)
Bank Name
Type of Account (Checking, Savings, etc.)
Average Balance ($)
Bank Name
Type of Account (Checking, Savings, etc.)
Average Balance ($)
Do you have a 401K or Retirement? If so, please list type and balance. (Borrower & Co-Borrower)
I authorize NorthSide Mortgage Group LLC to pull my tri-merge credit report for qualification purposes only. I am also authorizing NSMG, LLC to charge my debit/credit card below for the costs incurred for the report only. The cost of the report is displayed at the top of the credit report once pulled for verification purposes. The cost of an individual report is $48.30, joint is $96.60. YOU WILL NEED TO CALL OUR OFFICE TO PROVIDE PAYMENT. PLEASE TYPE YES IF YOU AGREE TO DO SO.
*
I agree to contact NorthSide Group (336-783-9100) to provide payment ASAP.
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