Application Form

USA PATRIOT ACT INFORMATION DISCLOSURE - IMPORTANT INFORMATION ABOUT APPLICATION PROCEDURES

To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify and record information that identifies every customer. What this means for you: When you apply for a loan, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.

LOAN APPLICATION FORM - Page 1 of 3

This is not a loan commitment form

Is this application for a purchase or refinance?

If you were referred to us, please put their name below:

purchase: refinance:
         
BORROWER INFORMATION        
Name: SSN:
Date of Birth:        
Are You: Married Unmarried
Separated
Do you: Own Rent
Address: City:
State:   Zip:
How long have you lived at this address?  
 
Home Phone #: Work Phone #:
Cell Phone: Email:
If you currently rent an appartment or home, what is your monthly payment?
How many dependents under the age of 18 do you have?
What are the ages of your dependents?
How many years of school have you completed after high school?
   
EMPLOYMENT INFORMATION  
Current employer: Are you self-employed? Yes
No
Employer address City
State Zip
Your title or job description: Years in this line of work:
How long have you worked for your current employer?
Please describe your compensation (hourly, salary, bonuses, commission, etc.)  
Hourly Wages How many hours do you work per week?
Yearly Salary      
Commission terms
Bonuses terms
   
EMPLOYMENT INFORMATION (2) Previous Secondary
Employer: Are you self-employed? Yes No
Employer address City
State Zip
Your title or job description: Years in this line of work:
How long have you worked for your current employer?
Please describe your compensation (hourly, salary, bonuses, commission, etc.)  
Hourly Wages How many hours do you work per week?
Yearly Salary      
Commission terms
Bonuses terms
 
INFORMATION FOR GOVERNMENT MONITORING
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. You may select one or more designations for "Race." The law provides that a lender may not discriminate on the basis of this information, or on whether you choose to furnish it. However, if you choose not to furnish the information and you have made this application in person, under federal regulations the lender is required to note ethnicity, race, and sex on the basis of visual observation or surname. If you do not wish to furnish the information, please check below.
Option: I do not wish to furnish this information
Sex: Male
Female
Ethnicity: Hispanic or Latino
Not Hispanic or Latino
Race: American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Have you filed your federal tax returns with the IRS for the past 2 years? Yes No

Do you owe the IRS any money for income taxes?

a). If yes, how much is owed?

b). Do you have a payment plan set up?

i). If yes, how much is the payment each month?

ii). If yes, when did this payment plan start?

Contact us

We're not around right now. But you can send us an email and we'll get back to you, asap.

Questions, issues or concerns? I'd love to help you!

Click ENTER to chat