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Form preview Mini mortgage loan application... Fax 281-500-4067 Short Form Mortgage Application Mini-1003 Page 1 of 2 DATE TIME LOAN OFFICER PURPOSE OF LOAN REFINANCE PURCHASE CONSTRUCTION EQUITY LINE PRIMARY BORROWER DOB //19 SSN -- PHONE H - PHONE W - PHONE C - CO-BORROWER DOB //19 CURRENT ADDRESS House No. Street City State Zip FOR PURCHASE LISTED HOME HOME TYPE SINGLE FAMILY DUPLEX MULTIPLEX TOWNHOME CONDO EST. MARKET VALUE HOME ADDRESS Y CASH OUT Y / N N AMOUNT REASON S FOR CASH YEAR PURCHASED YEAR BUILT ORIGINAL COST HOW LONG IN HOME ESCROW Y / NN MORTGAGE INS Y / N N AMT PER MO CURRENT MORTGAGE HOLDER MTG TYPE INTEREST RATE 0. 00 TERM YRS LEFT BALANCE MO PMT 2ND MORTGAGE/LINE OF CREDIT HOLDER MTG TYPE INTEREST RATE TERM YRS LEFT BALANCE MO PMT EMPLOYMENT HISTORY BORROWER EMPLOYER NAME EMPLOYER ADDRESS POSITION/TITLE YRS ON JOB YR GROSS INCOME MO / YR MO PAID ON W-2 SELF EMPL PREVIOUS EMPLOYER/PART TIME EMPLOYMENT INFO MO YR REVOLVING DEBT/MONTHLY OBLIGATIONS Majority of this information will be obtained via the credit report. DO YOU PAY CHILD SUPPORT OR ALIMONY Y / N N AMOUNT/MO REAL ESTATE TAXES Y / N N YEARLY MO IF KNOWN HOME INSURANCE CREDIT HISTORY Y / N N EXCELLENT AGREE TO CREDIT CHECK Y / NN GOOD AVERAGE HAVE YOU HAD ANY LATE PAYMENTS ON YOUR MORTGAGE PAST 12 MO CHALLENGED SCORE Y Y NN / DESCRIBE CREDIT ISSUES JUDGEMENTS BANKRUPTCY COLLECTIONS ASSETS CASH IN BANK ACCOUNTS include savings checking INVESTMENTS including 401K brokerage accounts stocks bonds Etc PROPERTY including rental units cabins 2nd homes land NOTES. MARKET VALUE HOME ADDRESS Y CASH OUT Y / N N AMOUNT REASON S FOR CASH YEAR PURCHASED YEAR BUILT ORIGINAL COST HOW LONG IN HOME ESCROW Y / NN MORTGAGE INS Y / N N AMT PER MO CURRENT MORTGAGE HOLDER MTG TYPE INTEREST RATE 0. 00 TERM YRS LEFT BALANCE MO PMT 2ND MORTGAGE/LINE OF CREDIT HOLDER MTG TYPE INTEREST RATE TERM YRS LEFT BALANCE MO PMT EMPLOYMENT HISTORY BORROWER EMPLOYER NAME EMPLOYER ADDRESS POSITION/TITLE YRS ON JOB YR GROSS INCOME MO / YR MO PAID ON W-2 SELF EMPL PREVIOUS EMPLOYER/PART TIME EMPLOYMENT INFO MO YR REVOLVING DEBT/MONTHLY OBLIGATIONS Majority of this information will be obtained via the credit report. 00 TERM YRS LEFT BALANCE MO PMT 2ND MORTGAGE/LINE OF CREDIT HOLDER MTG TYPE INTEREST RATE TERM YRS LEFT BALANCE MO PMT EMPLOYMENT HISTORY BORROWER EMPLOYER NAME EMPLOYER ADDRESS POSITION/TITLE YRS ON JOB YR GROSS INCOME MO / YR MO PAID ON W-2 SELF EMPL PREVIOUS EMPLOYER/PART TIME EMPLOYMENT INFO MO YR REVOLVING DEBT/MONTHLY OBLIGATIONS Majority of this information will be obtained via the credit report. DO YOU PAY CHILD SUPPORT OR ALIMONY Y / N N AMOUNT/MO REAL ESTATE TAXES Y / N N YEARLY MO IF KNOWN HOME INSURANCE CREDIT HISTORY Y / N N EXCELLENT AGREE TO CREDIT CHECK Y / NN GOOD AVERAGE HAVE YOU HAD ANY LATE PAYMENTS ON YOUR MORTGAGE PAST 12 MO CHALLENGED SCORE Y Y NN / DESCRIBE CREDIT ISSUES JUDGEMENTS BANKRUPTCY COLLECTIONS ASSETS CASH IN BANK ACCOUNTS include savings checking INVESTMENTS including 401K brokerage accounts stocks bonds Etc PROPERTY including rental units cabins 2nd homes land NOTES.

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