Mortgage Application
Purpose of Loan:
Select One
Purchase
Refinance
Construction
*
Property Type:
Select One
Single Family
Condo
2-4 Family
Other
To Be Determined
*
Property Use:
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Primary Residence
Second Home
Investment
*
Property Value:
$
*
purchase, aim high/refinance, aim low
Full Name:
*
Social Security #:
-
-
*
Home Phone:
-
-
*
E-Mail Address:
*
Work Phone:
-
-
Marital Status:
Select One
Married
Unmarried
Divorced
Separated
Other
*
Cell Phone:
-
-
Schooling:
Select One
12 - High School
16 - College
18 - Masters
18+
*
Date Of Birth:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
*
Day
1
2
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31
*
Year
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
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1968
1969
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1971
1972
1973
1974
1975
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1977
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1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
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1999
2000
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2003
2004
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2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
*
U.S. Citizen:
Yes
No
Please Select
Dependants:
Yes
No
How Many:
Ages:
(Format: 2, 7, 13)
Current Residence:
Select One
Own
Rent
Other
*
How long at this property?
Years
1
2
3
4
5
6
7
8
9
10+
Months
0
1
2
3
4
5
6
7
8
9
10
11
*
Address
*
*
State
ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING
*
*
Yearly Taxes:
Yearly Insurance:
$
$
Date Purchased:
*
*
Original Cost:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
*
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
$
A value is required.
Do You...
Yes No
Have a Home Equity Line or 2nd Mortgage?:
Select One
Own any other properties?:
Select One
Plan to make any changes to the Title?:
Select One
Escrow Preferences:
Select One
Taxes
Insurance
Both
None
*
Escrow Preferences
Taxes
Insurance
Both
None
*
Title Preferences
Single
Joint
Trust
Not Sure
*
Yes No Not Sure
Will gift funds be used?:
Select One
Is purchase contingent on sale of current residence?:
Select One
Could there be Septic/Title 5 Issue on current residence?:
Select One
Do you own any other Real Estate?:
Select One
Employer's Name:
Title/Position:
*
*
Address:
*
Just Base Salary:
$
*
*
State
ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING
*
*
Time:
At job
yrs
*
In field
yrs
*
If self employed, how long?:
Bonus/Commision Income:
*
yrs
Yes
No
Select One
Will there be a Co-Borrower?
Yes
No
Select One
Full Name:
*
Social Security #:
-
-
*
Date of Birth:
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
*
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
*
Year
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
*
Marital Status:
Select One
Married
Unmarried
Divorced
Separated
Other
*
U.S. Citizen:
Yes
No
*
Schooling:
Select One
12 - High School
16 - College
18 - Masters
18+
*
Will his/her income be used to qualify?
Yes
No
*
Dependants:
Yes
No
How Many:
*
Ages:
(Format: 2, 7, 13)
*
Employer's Name:
*
Title/Position:
*
Address:
*
Just Base Salary:
$
*
*
State
ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING
*
*
Time:
At job
*
yrs In field
*
yrs
If self employed, how long?:
*
Bonus/Commision Income:
Yes
No
Select One
Questions/Comments/Concerns:
*
- denotes a required field