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Uniform Residential Loan Application - Page 1 of 3

This application is designed to be completed by the applicant(s) with the lender's assistance. Applicants should complete this form as "Borrower" or "Co-Borrower", as applicable. Co-Borrower information must also be provided (and the appropriate box checked) when the income or assets of a person other than the "Borrower" (including the Borrower's spouse) will be used as a basis for loan qualification or the income or assets of the Borrower's spouse will not be used as a basis for loan qualification, but his or her liabilities must be considered because the Borrower resides in a community property state, the security property is located in a community property state, or the Borrower is relying on other property located in a community property state as a basis for repayment of the loan.

I. TYPE OF MORTGAGE AND TERMS OF LOAN
Mortgage V.A.__ Conventional __ Other: ___
Applied for: FHA ___ FmHA ___		 Agency Case #
 Lender Case #
Amount
$ 		Interest Rate
          %		 No. of Months
  		Amortization Fixed Rate __ Other (explain):


Type: GPM __ ARM(type): _______
II. PROPERTY INFORMATION AND PURPOSE OF LOAN
Subject Property Address (street , city, state, & zip)
 No. of Units

 
Legal Description of Subject Property (attach description if necessary)

 Year Built
Purpose of Loan Purchase __ Construction __
Other (explain):
Refinance ___ Construction-Permanent ___
 Property will be:
Primary Residence ___
Secondary Residence ___ Investment ___
Complete this line if construction or construction-permanent loan.
Year Lot
Acquired
 Original Cost
$
 Amount Existing Liens
$
 (a) Present Value of Lot
$
 (b) Cost of Improvements
$
 Total (a+b)
$
Complete this line if this is a refinance loan.
Year
Acquired
 Original Cost
$
 Amount Existing Liens
$
 Purpose of Refinance
 		 Describe Improvements to be made
Cost $
Borrower                   III. BORROWER INFORMATION             Co-Borrower
Borrower's Name (include Jr. or Sr. if applicable) 
 Co-Borrower's Name (include Jr. or Sr. if applicable
 
Social Security #
  		Home Phone (incl. area code)
 		 Age
 		 Yrs. School
 		 Social Security #
 		 Home Phone (incl. area code)
 		 Age
 		 Yrs. School
 
Married __
Unmarried (include single divorced, widowed) __
Separated __		 Dependents
(not listed by Co- Borrower)
no.__
ages ________ 		Married __
Unmarried (include single divorced, widowed) __
Separated ___		 Dependents
(not listed by Borrower)
no.__
ages _________
If residing at present address for less than two years, complete the following:
Previous Address (street, city, state, zip)

Own ___ Rent ___ No. Yrs.___

 Previous Address (street, city, state, zip)

Own ___ Rent ____ No. Yrs.___
Previous Address (street, city, state, zip)


Own ___ Rent ___ No. Yrs.___

 Previous Address (street, city, state, zip)


Own ___ Rent ___ No. Yrs.___
Borrower              IV. EMPLOYMENT INFORMATION              Co-Borrower
Name and Address of Employer


Self -Employed ___ 

Yrs. on this job
 Name and Address of Employer


Self- Employed ___ 

Yrs. on this job
Yrs. employed
in this line of
work/profession ___
 Yrs. employed
in this line of
work/profession ___
Position/Title/Type of Business Business Phone
(incl. area code)
 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:
Name and Address of Employer


Self -Employed ___ 

Dates(from-to)
 Name and Address of Employer


Self -Employed ___

 Dates(from-to)
Monthly Income
$		 Monthly Income
$
Position/Title/Type of Business
 Business Phone (incl. area code)
 Position/Title/Type of Business
 Business Phone (incl. area code)
Name and Address of Employer

Self -Employed ___

 Dates(from-to)
 Name and Address of Employer

Self -Employed ___

 Dates(from-to)
Monthly Income
$		 Monthly Income
$
Position/Title/Type of Business


 Business Phone (incl. area code)

 Position/Title/Type of Business

 Business Phone (incl. area code)

InterBanc Mortgage Services - 1003 Uniform Residential Loan Application - Print Form
http://www.interbancmortgage.com
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