Uniform Residential Loan Application

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This application is designed to be completed by the applicant(s) with the lender's assistance. Applicants should complete this form as "Borrower" or "Co-Borrower", as applicable. Co-Borrower information must also be provided (and the appropriate box checked) when the income or assets of a person other than the "Borrower" (including the Borrower's spouse) will be used as a basis for loan qualification or the income or assets of the Borrower's spouse will not be used as a basis for loan qualification, but his or her liabilities must be considered because the Borrower resides in a community property state, the security property is located in a commpunity property state, or the Borrower is relying on other property located in a community property state as a basis for repayment of the loan.

	* Required Field
Mortgage Applied For * Choose a mortgage type	VA FHA Conventional USDA/Rural Housing Other
Agency Case Number
Lender Case Number
Amount * Enter amount you are requesting
How much money are you requesting? Interest Rate
No. of Months
Amortization Type * Choose Amorization Type	Fixed Rate GPM ARM (type): Other (explain):

Subject Property
Property Street Address
City
County
State
Zip
No. Units
Legal Description
Year Built
Purpose of Loan * Choose a reason for the loan	Purchase Construction-Permanent Construction Refinance Other
Property will be * Choose Property Type	Primary Residence Secondary Residence Investment

Title Will be Held in What Name(s)?
Manner in Which Title Will be Held?
Source of Down Payment and Settlement Charges
Estate will be held in	Free Simple Leasehold
- Choose a mortgage type - Choose Amorization Type - Choose a reason for the loan - Choose Property Type

Borrower's Information
Name * Enter your name
Social Security Number
Date of Birth
Home Phone * Enter your home phone number
Current Address
City
State
Zip
Years at this address
Do you	Rent Own
Previous Address (if less than 2 years at present address)
City
State
Zip
Years at this address
Dependents Other Than Listed by Co-Borrower
Dependents ages
Marital Status	Married Separated Unmarried
Years School


Employment Information
Are you Self Employed?	Yes No
Employer
Work Phone
Years on this job
Address
Position/Occupation
Type of Business
Monthly Income

Previous Employment (if less than two years at present employer)
Name
Address
Length of Employment
Dates (from - to)
Monthly Income

Gross Monthly Income
Base Employment Income
Overtime
Bonuses
Commissions
Dividends/Interest
Net Rental Income
Other (before completing, see the notice in "describe other income," below)
Total

Describe Other Income Notice: Alimony, child support, or separate maintenance income need not be revealed if the Borrower (B) or Co-Borrower (C) do not choose to have it considered for repaying this loan. Include the type of Other Income and Monthly Amount below.


Present Monthly Housing Expense **
Rent
First Mortgage
Other Financing
Hazard Insurance
Real Estate Taxes
Mortgage Insurance
Homeowner Assn. Dues
Other
Total Monthly Payment
Utilities
Total

Proposed Monthly Housing Expense **
Rent
First Mortgage
Other Financing
Hazard Insurance
Real Estate Taxes
Mortgage Insurance
Homeowner Assn. Dues
Other
Total Monthly Payment
Utilities
Total

Co-Borrower's Information
Name Enter your name
Social Security Number
Date of Birth
Home Phone Enter your home phone number
Current Address
City
State
Zip
Years at this address
Do you	Rent Own
Previous Address (if less than 2 years at present address)
City
State
Zip
Years at this address
Dependents Other Than Listed by Co-Borrower
Dependents ages
Marital Status	Married Separated Unmarried
Years School


Employment Information
Are you Self Employed?	Yes No
Employer
Work Phone
Years on this job
Address
Position/Occupation
Type of Business
Monthly Income

Previous Employment (if less than two years at present employer)
Name
Address
Length of Employment
Dates (from - to)
Monthly Income

Gross Monthly Income
Base Employment Income
Overtime
Bonuses
Commissions
Dividends/Interest
Net Rental Income
Other (before completing, see the notice in "describe other income," below)
Total

Describe Other Income Notice: Alimony, child support, or separate maintenance income need not be revealed if the Borrower (B) or Co-Borrower (C) do not choose to have it considered for repaying this loan. Include the type of Other Income and Monthly Amount below.

- Enter your name - Enter your home phone number

Assets & Liabilities This Statement and any applicable supporting schedules may be completed jointly by both married and unmarried Co-Borrowers if their assets and liabilities are sufficiently joined so that the Statement can be meaningfully and fairly presented on a combined basis; otherwise separate Statements and Schedules are required. If the Co-Borrower section was completed about a spouse, this Statement and supporting schedules must be completed about that spouse also.
Completed	Jointly Not Jointly
Cash deposit toward purchase amount
Checking & Savings Accounts For each checking and savings account include Account Number, Amount of money in the account, Name and address of Bank, S&L, or Credit Union.

Stocks & Bonds For each stock or bond include Company Name, number, description, and Amount.

Life insurance net face amount
Life insurance net cash value
Subtotal Liquid Assets
Real estate owned (enter market value)
Vested interest in retirement fund
Net worth of business(es) owned
Automobiles owned (make, year, and cash or market value)
Other Assets (itemize)
Total Assets (a.)
Liabilities & Pledged Assets Liabilities and Pledged Assets. List the creditor's name, address and account number for all outstanding debts, including automobile loans, revolving charge accounts, real estate loans, alimony, child support, stock pledges, etc. Use continuation sheet, if necessary. Indicate by (*) those liabilities which will be satisfied upon sale of real estate owned or upon refinancing of the subject property. Include Account Number, Name and address of Company, Monthly payment amount, Months left to pay, and unpaid balance amount.

Alimony/Child Support/Separate Maintenance Payments Owed: (include name & amount)
Job Related Expense (child care, union dues, etc.)
Total Liabilities (b.)
Net Worth (a. minus b.)


Schedule of Real Estate Owned (if additional properties are own, use extra fields)
Property Address
Type of Property
Present Market Value
Amount of Mortgages & Liens
Gross Rental Income
Mortgage Payments
Insurance, Maintenance, Taxes & Misc.
Net Rental Income

Property Address
Type of Property
Present Market Value
Amount of Mortgages & Liens
Gross Rental Income
Mortgage Payments
Insurance, Maintenance, Taxes & Misc.
Net Rental Income

Property Address
Type of Property
Present Market Value
Amount of Mortgages & Liens
Gross Rental Income
Mortgage Payments
Insurance, Maintenance, Taxes & Misc.
Net Rental Income

List any additional names under which credit has previously been received and indicate appropriate creditor name(s) and account number(s):
Alternate Name
Creditor Name
Account Number

Alternate Name
Creditor Name
Account Number

Details of Transaction

a. Purchase Price

b. Alterations, improvements, repairs

c. Land (if acquired separately)

d. Refinance (include debts to be paid off)

e. Estimated prepaid items

f. Estimated closing costs

g. PMI, MIP, Funding Fee

h. Discount (if Borrower will pay)

i. Total costs (add items a through h)

j. Subordinate financing

k. Borrower's closing costs paid by Seller

l. Other Credits (explain)

m. Loan amount (exclude PMI, MIP, Funding Fee financed)

n. PMI, MIP, Funding Fee financed

o. Loan amount (m + n)

p. Cash from/to Borrower (subtract j, k, l & o from i)

Declarations

Borrower

Co-Borrower

Are there any outstanding judgments against you?

Yes
No

Have you been declared bankrupt within the past 7 years?

Yes
No

Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?

Yes
No

Are you a party to a law suit?

Yes
No

Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment? (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. If “Yes,” provide details, including date, name and address
of Lender, FHA or VA case number, if any, and reasons for the action.)

Yes
No

Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial
obligation, bond, or loan guarantee? If “Yes,” give details as described in the
preceding question.

Yes
No

Are you obligated to pay alimony, child support, or separate maintenance?

Yes
No

Is any part of the down payment borrowed?

Yes
No

Are you a co-maker or endorser on a note?

Yes
No

Are you a U.S. citizen?

Yes
No

Are you a permanent resident alien?

Yes
No

Do you intend to occupy the property as your primary residence?
(If “Yes,” complete
question below.)

Yes
No

Have you had an ownership interest in a property in the last three years?

Yes
No

What type of property did you own--principal residence (PR), second home (SH), or investment property (IP)?

Yes
No

How did you hold title to the home--solely by yourself (S), jointly with your spouse (SP), or jointly with another person (O)?

Yes
No

Acknowledgement & Agreement

Each of the undersigned specifically represents to Lender and to Lender’s actual or potential agents, brokers, processors, attorneys, insurers, servicers, successors and assigns and agrees and acknowledges that: (1) the information provided in this application is true and correct as of the date set forth opposite my signature and that any intentional or negligent misrepresentation of this information contained in this application may result in civil liability, including monetary damages, to any person who may suffer any loss due to reliance upon any misrepresentation that I have made on this application, and/or in criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Sec. 1001, et seq.; (2) the loan requested pursuant to this application (the “Loan”) will be secured by a mortgage or deed of trust on the property described herein; (3) the property will not be used for any illegal or prohibited purpose or use; (4) all statements made in this application are made for the purpose of obtaining a residential mortgage loan; (5) the property will be occupied as indicated herein; (6) any owner or servicer of the Loan may verify or reverify any information contained in the application from any source named in this application, and Lender, its successors or assigns may retain the original and/or an electronic record of this application, even if the Loan is not approved; (7) the Lender and its agents, brokers, insurers, servicers, successors and assigns may continuously rely on the information contained in the application, and I am obligated to amend and/or supplement the information provided in this application if any of the material facts that I have represented herein should change prior to closing of the Loan; (8) in the event that my payments on the Loan become delinquent, the owner or servicer of the Loan may, in addition to any other rights and remedies that it may have relating to such delinquency, report my name and account information to one or more consumer credit reporting agencies; (9) ownership of the Loan and/or administration of the Loan account may be transferred with such notice as may be required by law; (10) neither Lender nor its agents, brokers, insurers, servicers, successors or assigns has made any representation or warranty, express or implied, to me regarding the property or the condition or value of the property; and (11) my transmission of this application as an “electronic record” containing my “electronic signature,” as those terms are defined in applicable federal and/or state laws (excluding audio and video recordings), or my facsimile transmission of this application containing a facsimile of my signature, shall be as effective, enforceable and valid as if a paper version of this application were delivered containing my original written signature.

Borrower's Signature
Date

Co-Borrower's Signature
Date

Information for Government Monitoring Purposes
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 discriminate neither on the basis of this information, nor 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 or surname. If you do not wish to furnish the information, please check the box below. (Lender must review the above material to assure that the disclosures satisfy all requirements to which the lender is subject under applicable state law for the particular type of loan applied for.)
Borrower	I do not wish to furnish this information
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
Sex	Female Male

Co-Borrower	I do not wish to furnish this information
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
Sex	Female Male

Construction Lot Value Data
Year Acquired
Original Cost
Present Value (a)
Cost of Improvements (b)
Total (a + b)

Refinance Loan Informaiton
Purpose of Refinance
Year Acquired
Original Cost
Amount Existing Liens
Describe Improvements	Made To be made
Cost of Improvements

Card	VISA®	MasterCard
Annual Percentage Rate (APR) for Purchases (Variable)	16.15%**	13.75%***
Cash Advance APR (Variable)	16.15%**	13.75%***
Balance Transfer APR (Variable)	16.15%**	13.75%***
Grace Period for re-payment of balances for purchases	25 Days
Minimum Finance Charge	$1.00
Return Payment Fee	$25.00
Transaction Fee for Cash Advances	$5.00 or 3.0% of the amount advanced - whichever is greater.
Late Payment Fee	$25.00 - If the minimum required payment is not received within five days after the closing date subsequent to the payment due date, a late payment fee of $25.00 will be imposed.
Over-the-Credit-Limit Fee	$25.00
MasterCard’s currency conversion procedure includes use of either a government-mandated exchange rate, or a wholesale exchange rate selected by MasterCard, and that the government-mandated exchange rate or wholesale exchange rate MasterCard uses for a particular transaction is the rate MasterCard selects for the applicable currency on the day the transaction is processed, which may differ from that applicable to the date the transaction occurred or when it is posted to the cardholder’s account. Rate determined by adding 7.90% to the Prime Rate1. **Rate determined by adding 5.50% to the Prime Rate1. 1The prime rate used to determine your APR is the rate published in the money rate section of the Wall Street Journal on the 15th of June (or if the 15th is a Saturday, Sunday, or holiday, the next business day). Any change in the rate will go into effect on the first day of your new Billing Cycle beginning after July 1, and may result in an increase or decrease in the Finance Charge imposed on your account.

Uniform Residential Loan Application

Subject Property

Construction Lot Value Data

Refinance Loan Informaiton

Borrower's Information

Employment Information

Previous Employment (if less than two years at present employer)

Gross Monthly Income

Describe Other Income

Present Monthly Housing Expense **

Proposed Monthly Housing Expense **

Co-Borrower's Information

Employment Information

Previous Employment (if less than two years at present employer)

Gross Monthly Income

Describe Other Income

Assets & Liabilities

Checking & Savings Accounts

Stocks & Bonds

Liabilities & Pledged Assets

Schedule of Real Estate Owned (if additional properties are own, use extra fields)

List any additional names under which credit has previously been received and indicate appropriate creditor name(s) and account number(s):

Details of Transaction

Declarations

Acknowledgement & Agreement

Information for Government Monitoring Purposes

Previous Employment
(if less than two years at present employer)

Previous Employment
(if less than two years at present employer)

Schedule of Real Estate Owned
(if additional properties are own, use extra fields)