Loan Application - Page 1 of 4

E-mail Address:

Are you presently under contract? Yes No

Are you currently working with a Realtor or Builder? Yes No

If yes, state name:

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I. Type of Mortgage and Terms of Loan

Amount:

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II. Property Information and Purpose of Loan

Property Address:

Street:
City:
State:	Zipcode:

No. of Units:	Year Built:
Purpose of Loan: Purchase Refinance Construction Construction-Permanent Other If Other, explain:	Property will be: Primary Residence Secondary Residence Investment

Complete below if this is a refinance loan:

Year Acquired:	Original Cost:	Existing Liens:
Purpose of Refinance:

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III. Borrower Information

Borrower		Co-Borrower
Name (include Jr. or Sr. if applicable)		Name (include Jr. or Sr. if applicable)
Social Sec. No.		Social Sec. No.
Home Phone	Home Fax	Home Phone	Home Fax
Age	Yrs. of School	Age	Yrs. of School
Marital Status Married Unmarried Separated	Dependents No. Ages	Marital Status Married Unmarried Separated	Dependents No. Ages
Present Address:		Present Address:
Street		Street
City		City
State Country	Zip/Postcode	State Country	Zip/Postcode
Own Rent	No. of Years	Own Rent	No. of Years
If At Present Address Less Than Two Years...
Former Address		Former Address
Street		Street
City		City
State Country	Zip/Postcode	State Country	Zip/Postcode
Own Rent	No. of Years	Own Rent	No. of Years

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IV. Employment Information

Borrower		Co-Borrower
Name of Employer:		Name of Employer:
Attention:		Attention:
Address:		Address:
City:		City:
State Country	Zip/Postcode	State Country	Zip/Postcode
Self-Employed: Yes No	Years on this job:	Self-Employed: Yes No	Years on this job:
Years in current profession:		Years in current profession:
Position/Title/Type of Business:		Position/Title/Type of Business:
Business Phone:		Business Phone:
Business Fax:		Business Fax:
If Employed in Current Position for Less Than Two Years...
Name of Employer:		Name of Employer:
Attention:		Attention:
Address:		Address:
City:		City:
State Country	Zip/Postcode	State Country	Zip/Postcode
Self-Employed: Yes No	From-To:	Self-Employed: Yes No	From-To:
Monthly Income:		Monthly Income:
Position/Title/Type of Business:		Position/Title/Type of Business:
Business Phone:		Business Phone: