Residential Loan Application

Applicant E-Mail
Important: Enter a valid e-mail address. Correspondence will be sent to this address.
E-Mail:*
Applicant Personal and Employment Information
First Name:* Middle Initial: Last Name:*
Social Security Number*
Date of Birth:*
Home Phone:* Work Phone:* Cell Phone:
Address Line 1:* Address Line 2:
City:* State:* Zip Code:*
Do you own your home? Yes No
Current Occupation:* Current Employer or Business Name:* Business Address:*
Start Date:*
Gross Monthly Income:*
Other Income Source:
Note: Alimony,child support or separate maintenance income need not be revealed.
Total Monthly Liabilities:*
How is your credit?*
Have you ever filed for bankruptcy?*
Do you have collections, judgments, or liens?*
Do you have a down payment?* Yes No
If so, how much?
Desired Monthly Mortgage Payment:
Co-Applicant Personal and Employment Information
First Name: Middle Initial: Last Name:
Social Security Number
Date of Birth:
Home Phone: Work Phone: Cell Phone:
Address Line 1: Address Line 2:
City: State: Zip Code:
Do you own your home? Yes No
Current Occupation: Current Employer or Business Name: Business Address:
Start Date:
Gross Monthly Income:
Other Income Source:
Note: Alimony,child support or separate maintenance income need not be revealed.
Total Monthly Liabilities:
How is your credit?
Have you ever filed for bankruptcy?
Do you have collections, judgments, or liens?
Do you have a down payment? Yes No
If so, how much?
Desired Monthly Mortgage Payment:
Credit Authorization
I DECLARE THAT THE FOREGOING INFORMATION IS TRUE AND CORRECT. I AUTHORIZE ITS VERIFICATION
AND THE OBTAINING OF A CREDIT REPORT AND REVIEW OF MY EMPLOYMENT HISTORY.

I understand any false or misleading statements in my application may cause any loan to be in default. I agree
that this application shall be this Institutions`s property whether or not this credit application is approved.
Dated:*
By entering my first and last below, I hereby consent to have my credit report secured from a credit reporting agency.
Applicant`s First Name:* Applicant`s Last Name:*
Co-Applicant`s First Name: Co-Applicant`s Last Name:
Dated:
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