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FIRST
APPLICANT: |
First Name: |
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| Middle
Initial: |
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| Last
Name: |
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| Social
Security #: |
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| Birthday
(mm/dd/yy): |
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Application
Type: |
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Marriage Status: |
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Phone: |
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Email
Address:
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Housing
Information |
Present Address: |
(Number,
Street, Apt. P.O. Box)
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| City: |
|
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County: |
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| State: |
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| Zip: |
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How
Long? |
years
months
|
Previous Address:
(If
less than 5 years)
|
(Number,
Street, Apt. P.O. Box)
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| City: |
|
|
County: |
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| State: |
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| Zip: |
|
|
How
Long? |
years
months
|
|
Employment
Information |
Employer:
|
|
| How
Long? |
years
months
|
| Employer
Phone: |
|
| Position: |
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| Gross
Monthly Income: |
|
Previous Employer:
(If
less than 2 years @ current) |
|
| How
Long? |
years
months |
| Employer
Phone: |
|
| Position: |
|
| Gross
Monthly Income: |
|
| Additional
Income Source: |
|
Gross
Additional Income:
(monthly)
|
|
|
The
following information is requested by
the federal government for certain types
of loans related to a dwelling in order
to monitor the lender's compliance with
equal credit opportunity, fair housing,
and home mortgage disclosure laws.
'You are not required to furnish this
information, but are encouraged to do
so. The law provides that a lender
may not discriminate on this information
, or on whether you choose to furnish
it. However, if you choose not to
furnish this information, under federal
regulations,, the lender is required to
note ethnicity and sex on the basis of
visual observation or surname. If
you do not which to furnish this
information please select that option. |
|
Ethnicity |
|
|
Race or National
Origin: |
|
Sex:
|
|
|
SECOND
APPLICANT: |
First Name: |
|
| Middle
Initial: |
|
| Last
Name: |
|
| Social
Security #: |
|
| Birthday
(mm/dd/yy): |
|
| Daytime
Phone: |
|
Email
Address:
|
|
|
Second
Applicant Employment
Information |
Employer:
|
|
|
How
Long? |
years
months
|
| Employer
Phone: |
|
| Position: |
|
| Gross
Monthly Income: |
|
Previous Employer:
(If
less than 2 years @ current)
|
|
| How
Long? |
years
months
|
| Employer
Phone: |
|
| Position: |
|
| Gross
Monthly Income: |
|
| Additional
Income Source: |
|
Gross
Additional Income:
(monthly)
|
|
|
The
following information is requested by
the federal government for certain types
of loans related to a dwelling in order
to monitor the lender's compliance with
equal credit opportunity, fair housing,
and home mortgage disclosure laws.
'You are not required to furnish this
information, but are encouraged to do
so. The law provides that a lender
may not discriminate on this information
, or on whether you choose to furnish
it. However, if you choose not to
furnish this information, under federal
regulations,, the lender is required to
note ethnicity and sex on the basis of
visual observation or surname. If
you do not which to furnish this
information please select that option. |
|
Ethnicity |
|
|
Race or National
Origin: |
|
Sex:
|
|
|
GENERAL: |
Current Home Value: |
|
Purchase
Date
(ex. mm/dd/yy): |
|
| Purchase
Price: |
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| First
Lender: |
|
| Balance:
|
|
| Monthly
Payment: |
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| Second
Lender (if any):
|
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| Second
Balance:
|
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| Second
Monthly
Payment:
|
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| Last
Appraisal Amount: |
|
Last
Refinance Date:
(if
applicable) |
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| County: |
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| Other
Creditor: |
|
| Type:
|
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| Monthly
Payment: |
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| Balance: |
|
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WE
ARE REQUESTING FUNDS FOR: (select one) |
|
|
|
Contract Price:
|
$
|
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Down Payment: |
$
|
|
Amount
Requested: |
$
|
|
Term: |
months |
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Defer Payment: |
|
| |
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I certify
that I have read the information below. |
| |