Amount Requested: *
Term: *
Ex. 30 Year
Purchase Price:
Down Payment:
Purpose of Loan: *
Type of Loan: *
Type of Residence: *
Member/Account Number:
First Name: *
Middle Initial:
Last Name: *
Date of Birth: *
MM/DD/YYYY
Social Security Number: *
123-12-1234
Phone Number: *
E-Mail Address:
Street Address: *
City: *
State: *
Zip: *
*If Other Specify:
Ex. Live with Parents
Do You Own Or Rent?: *
How Long Own or Rent?: *
Employer: *
Employer Address: *
Work Phone: *
Years At This Employer: *
Position/Title: *
Gross Salary per Year: *
Co-Borrower Name:
If Applicable
Co-Borrower Street Address:
City:
State:
Zip:
Co-Borrower Phone:
Co-Borrower Date of Birth:
MM/DD/YYYY
Co-Borrower Social Security Number:
123-12-1234
Co-Borrower Employer:
Employer Address:
Work Phone:
Years At This Employer:
Position/Title:
Co-Borrower Gross Salary per Year:
Other Income:
Monthly Amount & Source
Rent/Mortgage:
Monthly Payment
Auto Loans:
Monthly Payments
Credit Cards:
Monthly Payment
Student Loans:
Monthly Payment
Alimony/Child Support:
Monthly Payment
Other Expenses:
Description & Monthly Payment
Checking Account(s):
Balances & Financial Institutions
Savings Account(s):
Balances & Financial Institutions
Mutual Funds:
Balances & Financial Institutions
Automobiles Owned:
Year, Make & Value
Other Assets:
Ex. Life Insurance,Retirement or Stocks & Bonds.
Do you authorize us to pull you and your co-borrower's credit reports in order to pre-qualify you for a loan?: *
Are there any outstanding judgements against you?: *
Have you ever been declared bankrupt within the past 7 years?: *
Have you ever had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?: *
Are you party to a lawsuit?: *
Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgement?: *
This would include such loans as home mortgage loans, SBA loans, home improvement loans, educational loans, manufactured (mobile) home loans, any mortgage, financial obligation, bond, or loan guarantee.
Are you presently delinquent or in default on any federal debt or any other loan, mortgage, financial obligation bond, or loan guarantee?: *
Are you obligated to pay alimony, child support, or separate maintenance?: *
Is, or will, any part of the down payment be borrowed?: *
Are you a co-maker or endorser on a note?: *
Are you a U.S. Citizen?: *
Are you a permanent resident alien?: *
Do you intend to occupy the property as your primary residence?: *
Have you had an ownership interest in a property in the last three years?: *
