Online Application
1. Type of Mortgage and Terms of Loan
Mortgage Applied for:
Loan Amount:
Interest Rate: %
No. of Months:
Amortization Type:
2. Property Information and Purpose of Loan
Subject Property Address:
City:
State:
ZIP Code:
Number of Units:
Purpose of Loan:
Property Will Be:
Purchase Price or Estimated Value:
Source of Down Payment, Settlement Charges, and/or Subordinate Financing:
Estate Will Be Held in:
Complete the items below if this is a construction, construction-permanent, or refinance loan:
Existing Liens: (Amount)
Purpose of Refinance:
3. Borrower Information (Help)
First Name: *
Middle Initial:
Last Name: *
Generation Suffix (if applicable):
(for example, Jr., Sr., or II)
Date of Birth: - -
 You may check my credit report at this time
Social Security Number: - -
Evening Phone: ( )  - *
Marital Status:
Number of Dependents:
(Count shared dependents once)
Email Address: *
Present Address
Street:
City:
State:
ZIP Code:
Rent or Own?
How Long at Address:  years    months
Complete the following if at present address less than two years:
Former Address
Street:
City:
State:
ZIP Code:
Rent or Own?
How Long at Address:  years   months
3a. Co-borrower Information (Help)
First Name:
Middle Initial:
Last Name:
Generation Suffix (if applicable):
(for example, Jr., Sr., or II)
 You may check my credit report at this time
Social Security Number: - -
Evening Phone: ( )  -
Marital Status:
Number of Dependents:
(Count shared dependents once)
Present Address ( Same as Borrower )
Street:
City:
State:
ZIP Code:
Rent or Own?
How Long at Address:  years   months
Complete the following if at present address less than two years.
Former Address ( Same as Borrower )
Street:
City:
State:
ZIP Code:
Rent or Own?
How Long at Address:  years   months
4. Employment Information (Help)
Current Employer
Borrower Co-borrower
Employer Name:
Self-employed: 
Time on Job:
  years    months
Employer Name:
Self-employed: 
Time on Job:
  years    months
Previous Employment
If employed in current position less than two years or if currently employed in more than one position, complete the following:
Borrower Co-borrower
Secondary Current
Employer: 
Employer Name:
Self-employed: 
Time on Job:
  years    months
Start Date: 
Secondary Current
Employer: 
Employer Name:
Self-employed: 
Time on Job:
  years    months
Start Date: 
Borrower Co-borrower
Secondary Current
Employer: 
Employer Name:
Self-employed: 
Time on Job:
  years    months
Start Date: 
Secondary Current
Employer: 
Employer Name:
Self-employed: 
Time on Job:
  years    months
Start Date: 
5. Monthly Income and Combined Housing Expense Information (Help)
Gross Monthly Income Borrower Co-borrower
Base Empl. Income:
Overtime:
Bonuses:
Commissions:
Dividends/Interest:

Describe Other Income: Notice: Alimony, child support, or separate maintenance need not be revealed if you do not choose to have it considered for repayment of this loan.
  Owner Description Monthly Amount
#1
#2
#3

Combined Monthly Housing Expense Where You Live Now Proposed Loan
Rent:  
First Mortgage (P&I):  
Other Financing (P&I):  
Hazard Insurance:  
Real Estate Taxes:
Mortgage Insurance:  
Homeowner Assn. Dues:
Other:  
6. Assets (Help)
This statement and any applicable supporting schedules may be completed jointly by both married and unmarried co-borrowers if their assets and liabilities are sufficiently joined so that the statement can be meaningfully and fairly presented on a combined basis; otherwise, separate statements and schedules are required. If the co-borrower section was completed about a spouse, this statement and supporting schedules must be completed about the spouse also.
List assets, including checking and savings accounts below.
Account Owner:
Asset Type:
Description:
Cash or Market Value:
Account Owner:
Asset Type:
Description:
Cash or Market Value:
Account Owner:
Asset Type:
Description:
Cash or Market Value:
Account Owner:
Asset Type:
All Other Assets:
Cash or Market Value:
Schedule of Real Estate Owned 
Current/Subject:
Property Disposition:
Property Street:
Property City:
Property State: