MORTGAGE APPLICATION Please enable JavaScript in your browser to complete this form.Purpose of Loan *Select OnePurchaseRefinanceConstructionProperty Type *Select OneSingle FamilyCondo2-4 FamilyOtherTo Be DeterminedProperty Use *Select OnePrimary ResidenceSecond HomeInvestmentProperty Value *Escrow PreferencesSelect OneTaxesInsuranceBothNoneTitle PreferencesSelect OneSingleJointTrustNot SureWill gift funds be used?YesNoMaybeName of GifterApprox. Gift AmountFull Legal Name *FirstMiddleLastEmail *Cell Phone *Work PhoneDate of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Social Security # *Marital Status *Select OneMarriedUnmarriedSeparatedSchooling *Select One12 - High School16 - College18 - Masters18+US Citizen? *YesNoAre you a permanent resident alien?YesNoDependants? *YesNoHow many dependants?Ages of dependants?(Format: 2, 7, 13)Current Residence Type *Select OneOwnRentOtherCurrent Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeHow long at this property? *Select OneLess than 1 year1 Year2 Years3 Years4 Years5 Years6 Years7 Years8 Years9 Years10 Years10+ Years20+ Years Is purchase contingent on sale of current residence? *YesNoMaybeDo you own any other Real Estate? *YesNoAddress of other Real EstateAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePurchase price of other Real EstateApprox. value of other Real EstatePrevious AddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeMove-In Date of Previous AddressMove-Out Date of Previous AddressDate PurchasedOriginal CostYearly TaxesYearly InsuranceInsurance Company / AgencyInsurance Policy NumberDo you have a home equity line or 2nd mortgage? *YesNoDo you own any other properties? *YesNoDo you plan to make any changes to the Title?YesNoEscrow PreferencesSelect OneTaxesInsuranceBothNoneEmployer's Name *Employer's Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeTitle/Position *Base Salary *Bonus/Commission IncomeYesNoYTD BonusTotal Bonus - last yearTotal Bonus - 2 years agoTime at Job *Select OneLess than 1 year1 Year2 Years3 Years4 Years5 Years6 Years7 Years8 Years9 Years10 Years10+ Years20+ YearsPrevious Employer's NamePrevious Employer's AddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeTitle/Position of Previous JobStart Date of Previous JobEnd Date of Previous JobTime in FieldSelect OneLess than 1 year1 Year2 Years3 Years4 Years5 Years6 Years7 Years8 Years9 Years10 Years10+ Years20+ Years30+ YearsIf self employed, how long?Select OneLess than 1 year1 Year2 Years3 Years4 Years5 Years6 Years7 Years8 Years9 Years10 Years10+ Years20+ Years30+ YearsWill there be a Co-Borrower? *YesNoCo-Borrower's - Full Legal NameFirstMiddleLastCo-Borrower's - EmailCo-Borrower's - Date of BirthCo-Borrower's - Social Security #Co-Borrower's - Marital StatusSelect OneMarriedUnmarriedSeparatedIs the Co-Borrower a US citizen?YesNoIs the Co-Borrower a permanent resident alien?YesNoCo-Borrower's - SchoolingSelect One12 - High School16 - College18 - Masters18+Will his/her income be used to qualify?YesNoDoes Co-Borrower have Dependents?YesNoHow many Dependants does Co-Borrower have?Ages of Co-Borrower's dependants?(Format: 2, 7, 13)Co-Borrower's - Employer's NameCo-Borrower's - Employer's AddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeCo-Borrower's - Title/PositionCo-Borrower's - Base SalaryCo-Borrower's - Time at jobCo-Borrower's - Years in fieldIf Co-Borrower is self employed, how long?Co-Borrower's - Bonus/Commission IncomeYesNoCo-Borrower's - YTD BonusCo-Borrower's - Total Bonus - last yearCo-Borrower's - Total Bonus - 2 years agoAssetsOnly fill out the ones that apply to you.CheckingApprox. BalanceSavingsApprox. BalanceMoney Market/ BrokerageApprox. BalanceRetirementApprox. BalanceGift from FamilyProceeds from Sale of a PropertyQuestions/Comments/ConcernsCommentSubmit