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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? *

Yes

No

Borrower Name *

Co-Borrower Name *

TYPE OF MORTGAGE LOAN AND TERMS OF LOAN

Conventional - On Demand Mortgage Loan

Loan Amount Requested *

Term *

PROPERTY INFORMATION AND PURPOSE OF LOAN

Property Address *

City *

State *

Zip

County *

Property Type *

Manufactured Home Land Interest *

Property Will Be *

Purpose of Loan *

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

Year Lot Acquired

Original Cost

Existing Liens

Present Value of Lot

Cost of Improvements

Complete this section if this is a refinance loan.

Original Cost

Existing Liens

Purpose of Refinance

Describe Improvements

Improvements

Made

To Be Made

Title will be held in what Name(s)

Manner in which title will be held

Purchase/Contract Price *

Source of Down Payment, Settlement Charges, and/or Subordinate Financing

BORROWER INFORMATION

Borrower

Name *

SSN *

Date of Birth * +

Primary Phone *

Primary Email *

Address *

City *

State *

ZIP *

Marital Status *

Married

Separated

Unmarried-single,divorced,widowed

Co-Borrower

Co-Borrower Name *

Co-Borrower SSN *

Co-Borrower DOB * +

Co-Borrower Primary Phone *

Co-Borrower Primary Email *

Same as Borrower's Address *

Yes

No

Co-Borrower Address *

Co-Borrower City *

Co- Borrower State *

Co-Borrower ZIP *

Co-Borrower Marital Status *

Married

Separated

Unmarried-single,divorced,widowed

Is your mailing address different than present address? *

Yes

No

Mailing Address *

City *

State *

ZIP *

EMPLOYMENT INFORMATION

Borrower Employment Type *

Employed (full-time/part-time)

Self-employment

I do not have employment income

Co-Borrower Employment Type *

Employed (full-time/part-time)

Self-employment

I do not have employment income

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

Employer Name & Address

Phone

Position/Title/Type of Business

Years Employed

Co-Borrower

Co-Borrower Employer Name & Address

Co-Borrower Phone

Co-Borrower Position/Title/Type of Business

Co-Borrower Years Employed

MONTHLY INCOME AND COMBINED HOUSING EXPENSES

Monthly Income

Overtime

Bonuses

Commissions

Dividends/Interest

Net Rental Income

Co-Borrower

Co-Borrower Monthly Income

Co-Borrower Overtime

Co-Borrower Bonuses

Co-Borrower Commissions

Co-Borrower Dividends/Interest

Co-Borrower Net Rental Income

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.

Type

Amount

How Often

Borrower

Co-Borrower

Type

Amount

How Often

Borrower

Co-Borrower

Type

Amount

How Often

Borrower

Co-Borrower

Monthly Housing Expense

Own or Rent?

Own

Rent

No. of Years

Payment Amount

Real Estate Taxes

Hazard Insurance

HOA Dues

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? *

Jointly

Not Jointly

Assets

Checking and Savings Accounts

1) Account Type

Bank Name/Account Number

Balance

2) Account Type

Bank Name/Account Number

Balance

3) Account Type

Bank Name/Account Number

Balance

4) Account Type

Bank Name/Account Number

Balance

5) Account Type

Bank Name/Account Number

Balance

6) Account Type

Bank Name/Account Number

Balance

Stocks and Bonds

Do you have Stocks or Bonds? *

Yes

No

Company Name/Number

Face Value

Cash Value

Company Name/Number

Face Value

Cash Value

Company Name/Number

Face Value

Cash Value

Do you have any additional Stocks or Bonds? *

Yes

No

Company Name/Number

Face Value

Cash Value

Company Name/Number

Face Value

Cash Value

Company Name/Number

Face Value

Cash Value

Life Insurance Net Cash Value

Vested Interest in Retirement Fund

Automobiles Owned

Make and Model

Year

Value

Make and Model

Year

Value

Make and Model

Year

Value

Schedule of Real Estate Owned

1) Property Address, City, State & Zip

Type of Property

Property Status

Market Value

Mortgage Balance

Mortgage Payment

Monthly Rental Income

Insurance & Taxes

Net Rental Income

2) Property Address, City, State & Zip

Type of Property

Property Status

Market Value

Mortgage Balance

Mortgage Payment

Monthly Rental Income

Insurance & Taxes

Net Rental Income

Do you have any additional real estate owned? *

Yes

No

3) Property Address, City, State & Zip

Type of Property

Property Status

Market Value

Mortgage Balance

Mortgage Payment

Monthly Rental Income

Insurance & Taxes

Net Rental Income

4) Property Address, City, State & Zip

Type of Property

Property Status

Market Value

Mortgage Balance

Mortgage Payment

Monthly Rental Income

Insurance & Taxes

Net Rental Income

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.

1) Company Name & Account #

Type

Balance

Months Left

Monthly Payment

2) Company Name & Account #

Type

Balance

Months Left

Monthly Payment

3) Company Name & Account #

Type

Balance

Months Left

Monthly Payment

4) Company Name & Account #

Type

Balance

Months Left

Monthly Payment

5) Company Name & Account #

Type

Balance

Months Left

Monthly Payment

6) Company Name & Account #

Type

Balance

Months Left

Monthly Payment

Alimony/ Child Support/ Separate Maintenance Payments

Are you required to pay alimony/ child support/ separate maintenance payments? *

Yes

No

Type

Monthly Amount

Payable to

Borrower

Co-Borrower

Type

Monthly Amount

Payable to

Borrower

Co-Borrower

DECLARATIONS

Answer the following. If you answer "Yes" to any questions, please explain below. *

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

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

If you answered "Yes" to any questions A through I, please explain below.

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. *

I AGREE to the Electronic Disclosure Authorization

I DO NOT AGREE to the Electronic Disclosure Authorization

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. *

I AGREE to the Electronic Disclosure Authorization

I DO NOT AGREE to the Electronic Disclosure Authorization

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. *

I AGREE to the Credit Check Authorization

I DO NOT AGREE to the Credit Check Authorization

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. *

I AGREE to the Credit Check Authorization

I DO NOT AGREE to the Credit Check Authorization

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. *

I AGREE to the Patriot Act

I DO NOT AGREE to the Patriot Act

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. *

I AGREE to the Patriot Act

I DO NOT AGREE to the Patriot Act

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 *

I AM a member of the U.S. Armed Forces, such as Army, Navy, Marine Corps, Air Force, or Coast Guard, serving on active duty under a call or order that does not specify a period of 30 days or fewer or on active Guard and Reserve duty (generally for a period of 180 consecutive days or more).

I AM a dependent of a member of the U.S. Armed Forces on active duty as described above. Dependents include, for example, a member's spouse, a member's child under the age of twenty-one years old, or an individual for whom the member provided more than one-half of the individual's financial support for 180 days immediately preceding today's date.

I AM NOT a regular or reserve member of the U.S. Armed Forces, such as Army, Navy, Marine Corps, Air Force, or Coast Guard, serving on active duty under a call or order that does not specify a period of 30 days or fewer or on active Guard and Reserve duty (or a dependent of such a member).

Co-Borrower *

I AM a member of the U.S. Armed Forces, such as Army, Navy, Marine Corps, Air Force, or Coast Guard, serving on active duty under a call or order that does not specify a period of 30 days or fewer or on active Guard and Reserve duty (generally for a period of 180 consecutive days or more).

I AM a dependent of a member of the U.S. Armed Forces on active duty as described above. Dependents include, for example, a member's spouse, a member's child under the age of twenty-one years old, or an individual for whom the member provided more than one-half of the individual's financial support for 180 days immediately preceding today's date.

I AM NOT a regular or reserve member of the U.S. Armed Forces, such as Army, Navy, Marine Corps, Air Force, or Coast Guard, serving on active duty under a call or order that does not specify a period of 30 days or fewer or on active Guard and Reserve duty (or a dependent of such a member).

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/Latino

Not Hispanic/Latino

I do not wish to provide

Hispanic or Latino *

Mexican

Puerto Rican

Cuban

Other Hispanic or Latino

Other Hispanic or Latino - Print origin, for example: Argentinean, Columbian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on *

Race (check one or more) *

Asian *

Native Hawaiian or Other Pacific Islander *

Native Hawaiian

Guamanian or Chamorro

Samoan

Other Pacific Islander

American Indian or Alaskan Native - Print name of enrolled or principal tribe: *

Other Asian - Print race, for example, Hmong, Laottan, Thai, Pakistani, Cambodian, and so on *

Other Pacific Islander - Print race, for example, Fijian, Tongan, and so on *

Sex *

Female

Male

I do not wish to provide

Co-Borrower

Ethnicity (check one or more) *

Hispanic/Latino

Not Hispanic/Latino

I do not wish to provide

Hispanic or Latino *

Mexican

Puerto Rican

Cuban

Other Hispanic or Latino

Other Hispanic or Latino - Print origin, for example: Argentinean, Columbian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on *

Race (check one or more) *

Asian *

Native Hawaiian or Other Pacific Islander *

Native Hawaiian

Guamanian or Chamorro

Samoan

Other Pacific Islander

American Indian or Alaskan Native - Print name of enrolled or principal tribe: *

Other Asian - Print race, for example, Hmong, Laottan, Thai, Pakistani, Cambodian, and so on *

Other Pacific Islander - Print race, for example, Fijian, Tongan, and so on *

Sex *

Female

Male

I do not wish to provide

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 *

I acknowledge receipt of this Notice of Right to Receive a Copy of Appraisal

Co-Borrower *

I acknowledge receipt of this Notice of Right to Receive a Copy of Appraisal

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.

Borrower's Name *

Co-Borrower's Name *

Originator Names and Nationwide Mortgage Licensing System and Registry IDs

Loan Origination Company's Name & Address

NMLS ID

Preferred Branch Location *

Loan Originator *

NMLSR ID # *

How did you learn about us? *

Existing Customer *

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