Mortgage Application Form

MORTGAGE APPLICATION FORM

Loan Request

Loan Purpose:   Requested Loan Amount:

Applicant Information

Date of Birth:   Social Security Number:

Years at Address:   Phone:   Email:

Employment and Income

Position/Title:   Years on Job:   Gross Monthly Income:

Co-Applicant (if applicable)

Date of Birth:   Social Security Number:

Property Information

Property Type: Single-Family    Condominium    2-4 Units

Occupancy: Primary Residence    Secondary Residence    Investment

Purchase Price / Estimated Value:   Down Payment:

Assets and Liabilities

Declarations

Have you declared bankruptcy in the past seven years?    Yes    No

Have you had a property foreclosed on in the past seven years?    Yes    No

Are you a party to a lawsuit or judgment?    Yes    No

Acknowledgement and Authorization

By submitting this application the Applicant certifies that the information provided herein is true, complete and correct to the best of Applicant's knowledge. Applicant understands that intentional misrepresentation or omission of material facts may constitute a fraudulent act that is subject to civil and criminal penalties under applicable law.

Applicant hereby authorizes the lender and its agents to obtain, verify and exchange credit, employment, bank, tax and other information necessary to evaluate this application, both prior to and after the loan closing. Applicant further authorizes third parties to release such information to the lender upon request. This authorization shall remain in effect until revoked in writing.

Applicant acknowledges that receipt of this application by the lender does not constitute approval or commitment to lend. Any approval is subject to appraisal, title clearance, underwriting, and the execution of final loan documents containing additional covenants and representations.

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