I. DEMOGRAPHICS
BORROWER 1 / BORROWER 2
FULL NAME (FIRST / MIDDLE / LAST)
AGE
DATE OF BIRTH
SOCIAL SECURITY NUMBER
NUMBER OF DEPENDENTS
AGE OF DEPENDENTS
MARITAL STATUS
YEARS OF SCHOOL COMPLETED( HS 12, BA/BS 16, etc)
HOME PHONE
WORK PHONE
CELL PHONE
EMAIL ADDRESS
CURRENTPHYSICAL STREETADDRESS
CITY, STATE, ZIP
TIME AT ADDRESS
DO YOU RENT OR OWN?
MONTHLY HOUSING EXPENSE (RENT OR PITI)
VALUE OF HOME (IF OWNED)
PREVIOUS ADDRESS (IF LESS THAN 2 YEARS)
CITY, STATE, ZIP
TIME AT ADDRESS
RENT OR OWN?
MONTHLY HOUSING EXPENSE
II. EMPLOYMENT INFORMATION
BORROWER 1 / BORROWER 2
NAME OF EMPLOYER
JOB TITLE/ PROFESSION
ADDRESS OF EMPLOYER
(WHERE YOU WORK PHYSICALLY WORK)
CITY, STATE, ZIP
START DATE / YEARS IN PROFESSION
GROSS MONTHLY INCOME (BEFORE TAXES)
SEPARATE BASE / BONUS / COMMISSION
PREVIOUS EMPLOYER (IF LESS THAN 2 YEARS)
POSITION / BUSINESS TYPE / YEARS IN PROFESSION
WORK PHONE
ADDRESS OF EMPLOYER
CITY, STATE, ZIP
START DATE
GROSS MONTHLY INCOME (BEFORE TAXES)
III. ASSETT INFORMATION
Bank Name / Balance / Bank Name / Balance
CHECKING
CHECKING
SAVINGS
SAVINGS
MONEY MARKET
CDS
STOCKS / BONDS ( Estimated Value)
401K/IRA (Balance)
MUTUAL FUNDS (Estimated Value)
OTHER ASSETS
IV. FNMA Questions
YES OR NO / Borrower 1 / Borrower 2
Is any portion of the down payment borrowed as a gift? (If yes, please indicate source of gift, amount, and relationship)
Are you obligated to pay Child Support or Alimony? (If yes, how much)
Do you have any outstanding Judgments?
Have you ever had a property foreclosed upon or given a deed in lieu of foreclosure?
Are you a co-signer or endorser on a note?
Are you a defendant or plaintiff in a lawsuit?
Have you directly or indirectly been obligated on any loan that resulted in foreclosure?
Have you declared bankruptcy in the last 7 years?
Are you presently delinquent or in default of any Federal debt, or any other loan, mortgage, financial obligation, bond or loan guarantee?
Are you a US citizen? (If No, please answer below)
Are you a permanent resident alien or non-permanent? What is your Visa Type?
V. NEW or EXISTING PROPERTY INFORMATION
PURCHASE PRICE/VALUE (Refinance)
DOWN PAYMENT/LOAN BALANCE (Refinance)
NEW LOAN AMOUNT REQUESTING
PROPERTY STREET ADDRESS
CITY, STATE, ZIP
OCCUPANCY (PRIMARY, VACATION, OR INVESTMENT)
SELLER NAME
SELLER CONTACT PHONE
VI. Optional Government Monitoring Questions
These questions are used to verify fair lending / BORROWER 1 / BORROWER 2
What is your gender? Male / Female
What race(s) best describe(s) you? (Please select all that apply)
American Indian / Native Alaskan
Asian
Black or African American
Native Hawaiian / Other Pacific Islander
White / Caucasian
What is your Ethnicity? (Hispanic or Non-Hispanic)
VII. NOTES
ADD ANY NOTES YOU WANT US TO KNOW ABOUT
This form is not an application for credit. To start the application process, your Mortgage Banker will need the information on this form, as well as your most current paystub and your W2 statements for the last two years. Only after a full mortgage loan application is completed and submitted can a loan decision be made.