BORROWER First Name*Middle InitialLast Name*Date of Birth* Date Format: MM slash DD slash YYYY Social Security Number (Format: 999-99-9999)Email...* Cell Phone Number...*Address*City*State*StateState...AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMarylandMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip*How long at current addressHow long at current address1 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 YearsLiving status at addressLiving status at addressOwnRentRent Free LOAN OFFICERPlease Select Your Loan Officer*Please Select Your Loan OfficerI do not have one yetBill Test INCOMENotice: 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 IncomeSource of Additional Income2nd JobOvertimeBonusCommissionContract LaborSocial SecurityAlimony/Child SupportRetirementNet Rental IncomeDividends/InterestOther EMPLOYMENT SECTIONEmployment StatusEmployment StatusEmployment StatusEmployedSelf EmployedUnemployed ASSETSChecking $...Savings $...Retirement Funds $...Other $... ADDITIONAL REAL ESTATE OWNEDDo You Own Additional Real Estate?Do You Own Additional Real Estate?Do You Own Additional Real Estate?YesNo ADDITIONAL DETAILSMarital StatusMarital StatusUnmarriedMarriedSeparatedDo You Pay Child Support Or Alimony?Do You Pay Child Support Or Alimony?YesNoIs This A Purchase Or Refinance?Is This A Purchase Or Refinance?PurchaseRefinanceAre You a Veteran?Are You a Veteran?YesNoFirst Time Home Buyer?First Time Home Buyer?YesNo CO-BORROWERClick Here If You Have A Co-Borrower Click Here If You Have A Co-Borrower HOW DID YOU HEAR ABOUT US?How Did You Hear About Us?How Did You Hear About Us?OtherInternetFriendRealtorBuilder AUTHORIZATIONBorrower Signature Borrower Signature I understand that by submitting this online application, I am authorizing a credit check and to make whatever inquiries necessary in connection with this request. INFO FOR GOVERNMENTThe 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. Government Monitoring I Do Not Wish To Furnish This InformationBorrowerCo-Borrower Ethnicity Hispanic Or LatinoBorrowerCo-BorrowerNot Hispanic Or LatinoBorrowerCo-Borrower Race American Indian Or Alaska NativeBorrowerCo-BorrowerNative Hawaiian Or Other Pacific IslanderBorrowerCo-BorrowerAsianBorrowerCo-BorrowerWhiteBorrowerCo-BorrowerBlack Or African AmericanBorrowerCo-Borrower Sex FemaleBorrowerCo-BorrowerMaleBorrowerCo-Borrower