Online Mortgage Application

Purpose:
  Pre-approval
  Seeking general information

This mortgage is for:
  Purchase
  Refinance

Is this for your primary residence?
  Yes
  No

Do you currently:
  Rent
  Own

What is your monthly payment?

BORROWER Name of Borrower: First:  Last:  Middle Initial:  Age: Marital Status   Married   Separated   Unmarried (single, divorced or widowed) Years in School: Number of Dependants: Dependants Ages: Employers Name: Your Job Position: Work phone number: Are you self employed?   Yes   No How long have you been on this job?   Years   Months Your gross monthly income: Additional sources of income: Amount of additional income per month: Social Security Number (optional, but required if you want us to pull a credit report)

CO-BORROWER Name of Co-Borrower: First:  Last:  Middle Initial:  Age: Marital Status   Married   Separated   Unmarried (single, divorced or widowed) Years in School: Number of Dependants: Dependants Ages: Employers Name: Your Job Position: Work phone number: Are you self employed?   Yes   No How long have you been on this job?   Years   Months Your gross monthly income: Additional sources of income: Amount of additional income per month: Social Security Number (optional, but required if you want us to pull a credit report) If Co-borrower is at a different address than Borrower: Your current address: Address   City State/Prov. Zip/Postal Day Phone PM Phone E-mail Fax How long have you been at this address? Do you currently:   Rent   Own What is your monthly payment?

Assets: (enter amounts for those that will be used for home purchase)

Checking
Savings/CDs
Retirement
Mutual fund
Stocks/bonds
Other
Gift

Debts:

Creditor	Monthly payment	Balance

Do you own other real estate?
  Yes
  No

If yes:
 

Address
City
State/Province
Zip/Postal
Mortgage balance
Payment
Value
Property type: (2nd home, investment, etc.)

What is your purchase price range?
  From $ to $

What is the maximum you want your payment to be?
  $

Please add any information or comments that may help us obtain your loan approval:

Authorization to Release Income Information
I/We authorize you to provide to the credit grantor, and to any potential investor or insurer of this credit transaction, federal and state records of employment and income history, including State Employment Security Agency records. This authorization is for this transaction only and continues in effect for one (1) year unless limited by state law, in which case the authorization continues in effect for the maximum period, not to exceed one (1) year, allowed by law.
I Agree I Do Not Agree