First Name*

Middle Initial*

Last Name*

Date of Birth*

Social Security Number*

Your Email*

Your Phone Number*

Address*

City*

State*

Zip Code*

How Long At Current Address*
—Please choose an option—1 year2 years3 years4 years5 years6 years7 years8 years9 years10 years11 years12 years13 years14 years15 years16 years17 years18 years19 years20 years21 years22 years23 years24 years25 years26 years27 years28 years29 years30 years30+ years

Living Status at Address*
—Please choose an option—OwnRentRent Free

LOAN OFFICER

Select Your Loan Officer*
—Please choose an option—Team Member 1Team Member 2Team Member 3Please Provide One For Me

INCOME

NOTICE: Alimony, Child Support Or Separate Maintenance Income need not be revealed if the borrower or co-borrower does not choose to have it considered for repaying this loan.

Gross Monthly Income*

Additional Monthly Income*

Source Of Additional Monthly Income*

EMPLOYMENT STATUS

Employment*
—Please choose an option—EmployedSelf EmployedUnemployed

ASSETS

Checking*

Savings*

Retirement*

Other*

ADDITIONAL REAL ESTATE OWNED

Do you own additional real estate?*
—Please choose an option—YESNO

ADDITIONAL DETAILS

Marital Status*
—Please choose an option—SingleMarriedSeparated

Do you pay child support or Alimony*
—Please choose an option—YESNO

Is this a Purchase or Refinance? *
—Please choose an option—PurchaseRefinance

Are you a Veteran? *
—Please choose an option—YESNO

Are you a first time home buyer? *
—Please choose an option—YESNO

CO-BORROWER

Do you have a co-borrower? *
—Please choose an option—YESNO

INFO FOR GOVERNMENT

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 Either On The Basis Of This Information, Or On Whether You Choose To Furnish It. If You Furnish The Information, Please Provide Both Ethnicity And Race. For Race, You May Check More Than One Designation. If You Do Not Furnish Ethnicity, Race, Or Sex, Under Federal Regulations, This Lender Is Required To Note The Information On The Basis Of Visual Observation And Surname If You Have Made This Application In Person. If You Do Not Wish To Furnish The Information, Please Check The Box Below.

Ethnicity *
—Please choose an option—HispanicLatinoOther

Race *
—Please choose an option—American Indian Or Alaska NativeNative Hawaiian Or Other Pacific IslanderAsianAfrican AmericanOther

Sex *
—Please choose an option—MaleFemale

AUTHORIZATION

  By checking this box, I grant that this information is to be used to pre-qualify me for a mortgage loan, including the right to obtain my credit report. I understand that the information will remain private and confidential. By submitting and signing this electronically, this application is to be deemed the equivalent of the original.

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