Loan Application Form

UNIFORM RESIDENTIAL LOAN APPLICATION
Borrower Information
Full Name

First NameMiddle NameLast NameSuffix
Social Security Number
Date of Birth

MonthDayYear
Marital Status:
Home Phone Number

Area CodePhone Number
Cell Phone Number:

Area CodePhone Number
E-mail
Present Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
How long have you lived at your current address?
Do you Own or Rent?
Monthly rent amount? (If applicable)
Previous Address if you have lived at your current address for less than 2 years

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
How long did you live at this address:
Mailing Address, if different than Present Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Employer Information
Employment Status:
Present Employer:
Your Position:
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Employer Phone Number

Area CodePhone Number
Start date

MonthDayYear
Gross Monthly Income:
How many years have you been employed in this line of work?
Verification Of Employment

Please list the contact information to your current Employers' Human Resources Department or to a company employee who can verify your employment status. Include a fax number, phone number or website if applicable.
Verification of Employment Instructions:
If you have been employed for less than 2 full years with your present employer, please complete the Previous Employer Information.
Previous Employer:
Position:
Previous Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Gross Monthly Income $
Start date:

MonthDayYear
Stop date:

MonthDayYear
Other Sources of Income
List all other sources of income not listed above (If applicable).
Source #1 and Monthly Income:
Source #2 and Monthly Income:
Source #3 and Monthly Income:
Monthly Debts
Debt #1
Monthly payment
Debt #2
Monthly payment
Debt #3
Monthly payment
Debt #4
Monthly payment
Debt #5
Monthly payment
Debt #6
Monthly payment
Debt #7
Monthly payment
Debt #8
Monthly payment
Debt #9
Monthly payment
Debt #10
Monthly payment
Credit Score
Please select your credit score:
Assets (Source of Down Payment)
Asset #1

Institution NameBalance
Asset #2

Institution NameBalance
Asset #3

Institution NameBalance
Asset #4

Institution NameBalance
Asset #5

Institution NameBalance
Other Real Estate Owned (If Applicable)
Other Real Estate Owned #1

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Other Real Estate Owned #2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Other Real Estate Owned #3

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Declarations
Are you or your spouse a Veteran?
Are there any oustanding judgments against you?
Have you been declared bankrupt within the past 7 years?
Have you had a 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?
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 seperate maintenance?
Is any part of the down payment borrowed?
Are you a co-maker or endorser on a note?
If you answer "Yes" to any of the above declarations, please explain:
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 you have had ownership in a property in the last three years, what type of property did you own?
If you have had ownership in a property in the last three years, how did you hold title?
How many of years school did you attend?
How many Dependents do you claim?
If you claim Dependents, what are they're ages?
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 not discriminate either on the basis of this information, or on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, this lender is required to note the information on the basis of visual observation and surname if you have made this application in person. If you do not wish to furnish the information, please check the box below. (Lender must review the above material to assure that the disclosures satisfy all requirements to which the lender is subject under applicable state law for the particular type of loan applied for.)
Opt out:
Ethnicity:
Race:
Should be Empty: