Online Loan Application

Loan Officer

Borrower's Name (please list name on social security card)

PrefixFirst NameMiddle NameLast NameSuffix

Date of Birth

MM / DD / YYYY

Social Security Number

999-99-9999

Email

Confirmation EmailPlease confirm email address

Current Address

Street Address

Street Address Line 2

CityState

Zip Code

Phone Number

Area CodePhone Number

Number of Years at this Address

List in years

Do You?

Marital Status

Number of Dependents

Type #

Ages of Dependents

List all ages

Previous Address (if less than 2 years)

Street Address

Street Address Line 2

CityState

Zip Code

Current Employer Name

Employer Address

Street Address

Street Address Line 2

CityState

Zip Code

Phone Number

Area CodePhone Number

Position

Type of Employment

Length on Job

(Years, months)

Previous Employer Name (if less than 2 years)

Previous Employer Address

Street Address

Street Address Line 2

CityState

Zip Code

Previous Phone Number

Area CodePhone Number

Previous Position

Previous Type of Employment

Previous Length on Job

(Years, months)

Gross Monthly Income

Rows	Gross Monthly Amount
Base Salary
Overtime
Bonus
Commissions
Other

Assets

Rows	Balance
Checking
Savings
Money Market
401k/Retirement
Other

Will there be a co-borrower on this loan?

Borrower's Name (please list name on social security card)

PrefixFirst NameMiddle NameLast NameSuffix

Date of Birth

MM / DD / YYYY

Social Security Number

999-99-9999

Email

Confirmation EmailPlease confirm email address

Current Address

Street Address

Street Address Line 2

CityState

Zip Code

Phone Number

Area CodePhone Number

Number of Years at this Address

List in years

Do You?

Marital Status

Number of Dependents

Type #

Ages of Dependents

List all ages

Previous Address (if less than 2 years)

Street Address

Street Address Line 2

CityState

Zip Code

Current Employer Name

Employer Address

Street Address

Street Address Line 2

CityState

Zip Code

Phone Number

Area CodePhone Number

Position

Type of Employment

Length on Job

(Years, months)

Previous Employer Name (if less than 2 years)

Previous Employer Address

Street Address

Street Address Line 2

CityState

Zip Code

Previous Phone Number

Area CodePhone Number

Previous Position

Previous Type of Employment

Previous Length on Job

(Years, months)

Gross Monthly Income

Rows	Gross Monthly Amount
Base Salary
Overtime
Bonus
Commissions
Other

Assets

Rows	Balance
Checking
Savings
Money Market
401k/Retirement
Other

Please answer the following questions to the best of your knowledge.

Declarations

Rows	B1 - Yes	B1 - No	CB - Yes	CB - No
A. Will you occupy the property as your primary residence?
A.1 If YES, have you had any ownership in another property in the last 3 years?
B. If this is a purchase transaction: Do you have family relationship or business affiliation with the seller of the property?
C. Are you borrowing any money for this real estate transaction (e.g., money for your closing costs or down payment) or obtaining any money from another party, such as the seller or realtor that you have not disclosed on this loan application?
D. 1. Have you or will you be applying for a mortgage loan on another property (not the property securing this loan) on or before closing this transaction that is not disclosed on this loan application?
E. Will this property be subject to a lien that could take priority over the first mortgage lien, such as a clean energy lien paid through your property taxes (e.g., the Property Assessed Clean Energy Program)?
F. Are you a co-signer or guarantor on any debt or loan that is not disclosed on this application?
H. Are you currently delinquent or in default on a Federal debt?
J. Have you conveyed title to any property in lieu of foreclosure in the past 7 years?
M. Have you declared bankruptcy within the past 7 years?

Purpose of Loan

Purchase Price

Estimated Value (for Refinance)

Name of Real Estate Agent (if purchasing)

Comments (Please add any additional information you thing would help in processing your loan.)

0/100

Were you referred to Charity Martin? If yes, by whom?

Authorization

Authorization to check credit verification I hereby authorize the lender to verify my past and present employment earnings records, bank accounts, stock holdings and any other asset balances that are needed to process my mortgage loan application. I further authorize the lender to order a consumer credit report and verify other credit information, including past and present mortgage and landlord references. It is understood that my acceptance will also serve as authorization. The information the lender obtains is only to be used in the processing of my application for a mortgage loan.

Date of Birth

MM / DD / YYYY

Social Security Number

999-99-9999

Email

Confirmation EmailPlease confirm email address

Date of Birth

MM / DD / YYYY

Social Security Number

999-99-9999

Email

Confirmation EmailPlease confirm email address

Borrower Signature

For Texas Borrowers:

CONSUMERS WISHING TO FILE A COMPLAINT AGAINST A MORTGAGE BANKER OR A LICENSED MORTGAGE BANKER RESIDENTIAL MORTGAGE LOAN ORIGINATOR SHOULD COMPLETE, SIGN AND SEND A COMPLAINT FORM TO THE TEXAS DEPARTMENT OF SAVINGS AND MORTGAGE LENDING, 2601 NORTH LAMAR, SUITE 201, AUSTIN, TEXAS 78705. COMPLAINT FORMS AND INSTRUCTIONS MAY BE DOWNLOADED AND PRINTED FROM THE DEPARTMENT’S WEBSITE AT WWW.SML.TEXAS.GOV. A TOLL-FREE CONSUMER HOTLINE IS AVAILABLE AT 1-877-276-5550.

THE DEPARTMENT MAINTAINS A RECOVERY FUND TO MAKE PAYMENTS OF CERTAIN ACTUAL OUT OF POCKET DAMAGES SUSTAINED BY BORROWERS CAUSED BY ACTS OF LICENSED MORTGAGE BANKER RESIDENTIAL MORTGAGE LOAN ORIGINATORS. A WRITTEN APPLICATION FOR REIMBURSEMENT FROM THE RECOVERY FUND MUST BE FILED WITH AND INVESTIGATED BY THE DEPARTMENT PRIOR TO THE PAYMENT OF A CLAIM. FOR MORE INFORMATION ABOUT THE RECOVERY FUND, PLEASE CONSULT THE DEPARTMENT’S WEB SITE AT WWW.SML.TEXAS.GOV.

Interest rates, program terms, and conditions are subject to change without notice. Not all products are available in all states or for all loan amounts. Loans are subject to credit review and approval. Properties securing all loans must be located in the U.S. Other restrictions and limitations may apply.

Charity Martin - RMLO - Branch Manager

Opal Morris - RMLO

Dalya Stephens - RMLO

Online Loan Application

Borrower

Borrower

Borrower

Co-Borrower's Information

Co-Borrower

Co-Borrower

Declarations

Property Information

Validation

Borrower's Information

Co-Borrower's Information