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UNIFORM RESIDENTIAL MORTGAGE APPLICATION

INDIVIDUAL/JOINT CREDIT

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 or other person who has community property or similar rights pursuant to applicable state law will not be used as a basis for loan qualification, but his or her liabilities must be considered because the spouse or other person who has community property or similar rights and the Borrower resides in a community property state, the security property is located in a community property state, or the Borrower is relying on other property located in a community property state as a basis for repayment of the loan.  If this is an application for joint credit, Borrower and Co-Borrower each agree that we intend to apply for joint credit.
Are you applying for Joint Credit? *

TYPE OF MORTGAGE LOAN AND TERMS OF LOAN

Conventional - On Demand Mortgage Loan

PROPERTY INFORMATION AND PURPOSE OF LOAN

Complete this section if this is a construction or construction-permanent loan.
Complete this section if this is a refinance loan.
Improvements

BORROWER INFORMATION

Borrower
calendar
Marital Status *
Co-Borrower
calendar
Same as Borrower's Address *
Marital Status *
Is your mailing address different than present address? *

EMPLOYMENT INFORMATION

Borrower Employment Type *
Co-Borrower Employment Type *
*Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.
Co-Borrower                                                                                                                                                                                                

MONTHLY INCOME AND COMBINED HOUSING EXPENSES

Co-Borrower                                                                                                                                                                                                             
Describe Other Income *See Notice Below
*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.
Monthly Housing Expense
Own or Rent?

ASSETS AND 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 is completed about a non-applicant spouse or other person, this Statement and supporting schedules must be completed about that spouse or other person also.
How are you completing this section? *
Assets
Checking and Savings Accounts
Stocks and Bonds
Do you have Stocks or Bonds? *
Do you have any additional Stocks or Bonds? *
Automobiles Owned
Schedule of Real Estate Owned
Do you have any additional real estate owned? *
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.
Alimony/ Child Support/ Separate Maintenance Payments
Are you required to pay alimony/ child support/ separate maintenance payments? *

DECLARATIONS

Answer the following. If you answer "Yes" to any questions, please explain below. *
 YesNo
A. Are there any outstanding judgments against you?
B. Have you been declared bankrupt within the past 7 years?
C. Have you had property foreclosed upon or given title or deed in lieu therefor in the last 7 years?
D. Are you a party to a lawsuit?
E. Have you directly or indirectly been obligated on any loan of 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. )
F. Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee?
G. Are you obligated to pay alimony, child support, or separate maintenance?
H. Is any part of the down payment borrowed?
I. Are you a co-maker or endorser on a note?
J. Are you a U.S. citizen?
K. Are you a permanent resident alien?
L. Do you intend to occupy the property as your primary residence?
Space If you ans "Yes" to any questions, please explain belowAnswer the following. If you answer es" to       sBorrower/Joint  Answer the following. If you answer "Yes" to any questions, please explain below. *
Yes NoYes No
YesNoYesNo
A. Are there any outstanding judgments against you?
B. Have you been declared bankrupt within the past 7 years?
C. Have you had property foreclosed upon or given title or deed in lieu therefor in the last 7 years?
D. Are you a party to a lawsuit?
E. Have you directly or indirectly been obligated on any loan of 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. )
F. Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee?
G. Are you obligated to pay alimony, child support, or separate maintenance?
H. Is any part of the down payment borrowed?
I. Are you a co-maker or endorser on a note?
J. Are you a U.S. citizen?
K. Are you a permanent resident alien?
L. Do you intend to occupy the property as your primary residence?

AUTHORIZATIONS & DISCLOSURES

ELECTRONIC DISCLOSURE AUTHORIZATION

The Electronic Disclosure and Consent contains important information that you are entitled to receive before you consent to transact business with us electronically. Please read this notice and print or download a copy for your files.
Borrower
I have read and agree to accept account disclosures online and affirmatively consent to receive the required disclosures in electronic form, including disclosures required by the Truth in Lending Act, Real Estate Settlement Procedures Act and Equal Credit Opportunity Act. Paper copies will be provided for certain real estate related transactions after your loan application is received. I also agree to receive communications regarding the status of my application electronically via the email address provided with the online application. *
Co-Borrower
I have read and agree to accept account disclosures online and affirmatively consent to receive the required disclosures in electronic form, including disclosures required by the Truth in Lending Act, Real Estate Settlement Procedures Act and Equal Credit Opportunity Act. Paper copies will be provided for certain real estate related transactions after your loan application is received. I also agree to receive communications regarding the status of my application electronically via the email address provided with the online application. *

CREDIT CHECK AUTHORIZATION

Borrower
I hereby grant permission for you to obtain all information deemed necessary to process your mortgage loan application. This information includes, but is not limited to, your past and present employment status, your deposit accounts, your past and present consumer credit record, your mortgage record and/or your rental record. *
Co-Borrower
I hereby grant permission for you to obtain all information deemed necessary to process your mortgage loan application. This information includes, but is not limited to, your past and present employment status, your deposit accounts, your past and present consumer credit record, your mortgage record and/or your rental record. *

PATRIOT ACT

Borrower
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 each person who opens an account. What this means for you: As part of applying for your mortgage 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. *
Co-Borrower
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 each person who opens an account. What this means for you: As part of applying for your mortgage 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. *

MILITARY LENDING ACT

Federal law provides important protections to active duty members of the Armed Forces and their dependents. To ensure that these protections are provided to eligible applicants, we require you to select one of the following statements as applicable.
 
Warning: It is important to fill out this section accurately. Knowingly making a false statement on a credit application is a crime.
Borrower *
Co-Borrower *

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 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. (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
Ethnicity (check one or more) *
Hispanic or Latino *
Race (check one or more) *
Asian *
Native Hawaiian or Other Pacific Islander *
Sex *
Co-Borrower
Ethnicity (check one or more) *
Hispanic or Latino *
Race (check one or more) *
Asian *
Native Hawaiian or Other Pacific Islander *
Sex *

NOTICE OF RIGHT TO RECEIVE A COPY OF APPRAISAL

We may order an appraisal to determine the property's value and charge you for this appraisal. We will promptly give you a copy of any appraisal, even if your loan does not close.
 
You can pay for an additional appraisal for your own use at your own cost.
Borrower *
Co-Borrower *

ACKNOWLEDGMENT AND 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 of submission 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 in this application; (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 in this application; (6) the Lender, its servicers, successors or assigns may retain the original and/or an electronic record of this application, whether or not the Loan is 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 Lender, its servicers, successors or assigns 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 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.

Acknowledgement. Each of the undersigned hereby acknowledges that any owner of the Loan, its servicers, successors and assigns, may verify or reverify any information contained in this application or obtain any information or data relating to the Loan, for any legitimate business purpose through any source, including a source named in this application or a consumer reporting agency.

Originator Names and Nationwide Mortgage Licensing System and Registry IDs

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