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Mortgage Loan Application

Please provide all the requested information. When you have completed the form, press the Submit button to send your application. If necessary, we will contact you for additional information.

The items marked with (*) are required fields.

General Information

Will you be applying for Individual or Joint Credit? Joint Individual

(If Joint, the co-applicant section has the same required fields as the primary applicant.)


Marital Status: Complete marital status if this loan is for:
a. Joint or secured credit, or
b. You reside in or rely on property located in a Community Property State. (AZ, CA, ID, LA, NM, NV, TX, WA, WI)
Unmarried
Married
Separated
This application is not for joint or secured credit and I do not live in the states listed above.

*Type of Loan Requested
*Loan Amount Requested
*Loan Term Requested
*Interest Rate Requested

Primary Applicant

*Member Number
*Last Name
*First Name
Middle Name
*Social Security Number (TIN)
*Date of Birth mm/dd/yyyy
Number of Dependents
Ages of Dependents
*Home Phone Number xxx-xxx-xxxx
Work Phone Number xxx-xxx-xxxx
Cell Phone Number xxx-xxx-xxxx
Email Address

Drivers License #
Drivers License State

Mother's Maiden Name

Home Address

*Address 1
Address 2
*City
*State
*Zip
Time at Current Residence Years Months
Residence Type Own Rent Other
Monthly Payment $

Previous Address

*Address 1
Address 2
*City
*State
*Zip
Time at Current Residence Years Months
Residence Type Own Rent Other

Present Employer

Name
Phone Number xxx-xxx-xxxx
Employment Status Full Time Part Time Temp
Retired Other
Job Title
Job Start Date mm/dd/yyyy
Gross Salary $

Alimony, child support, or separate maintenance income need not be revealed
if you do not wish to have it considered as a basis for repaying this obligation.

Other Income $
Other Income Source

Previous Employer

Name
Phone Number xxx-xxx-xxxx
Employment Status Full Time Part Time Temp
Retired Other
Job Title
Job Start Date mm/dd/yyyy
Job End Date mm/dd/yyyy
Gross Salary $
Co-Applicant
*Member Number
*Last Name
*First Name
Middle Name
*Social Security Number (TIN)
*Date of Birth mm/dd/yyyy
Number of Dependents
Ages of Dependents
*Home Phone Number xxx-xxx-xxxx
Work Phone Number xxx-xxx-xxxx
Cell Phone Number xxx-xxx-xxxx
Email Address

Drivers License #
Drivers License State

Mother's Maiden Name

Home Address

*Address 1
Address 2
*City
*State
*Zip
Time at Current Residence Years Months
Residence Type Own Rent Other
Monthly Payment $

Previous Address

*Address 1
Address 2
*City
*State
*Zip
Time at Current Residence Years Months
Residence Type Own Rent Other

Present Employer

Name
Phone Number xxx-xxx-xxxx
Employment Status Full Time Part Time Temp
Retired Other
Job Title
Job Start Date mm/dd/yyyy
Gross Salary $

Alimony, child support, or separate maintenance income need not be revealed
if you do not wish to have it considered as a basis for repaying this obligation.

Other Income $
Other Income Source

Previous Employer

Name
Phone Number xxx-xxx-xxxx
Employment Status Full Time Part Time Temp
Retired Other
Job Title
Job Start Date mm/dd/yyyy
Job End Date mm/dd/yyyy
Gross Salary $

References

Nearest relative Not Living With You

Last Name
First Name
Relationship
Phone Number xxx-xxx-xxxx
Address 1
Address 2
City
State
Zip

Credit and Asset Information

Monthly Obligations:
Installment Payments $
Revolving Payments $
Mortgage Payments/Rent $
Other Obligations $

Assets:

Liquid Assets (cash, savings, etc.) $
Stocks, Bonds, Mutual Funds, etc. $
Fixed Assets (Real Estate, personal property) $

Miscellaneous Property Information

If you have property picked out, this does not obligate you to buy.
Property Type
Property Address 1
Property Address 2
Property City
State
Zip -
Annual Property Taxes $
Annual Hazard Insurance $
Annual Condo/PUD Fees $

Home Mortgage Disclosure Act (HMDA)

Only complete this section for closed-end fixed rate Home Equity loans that are for Home Improvement purposes.

Please Note: 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. You may select one or more designations for “Race. ” The law provides that a lender may not discriminate on the basis of this information, or on whether you choose to furnish it. However, if you choose not to furnish the information and you have made this application in person, under federal regulations the lender is required to note ethnicity, race, and sex on the basis of visual observation or surname. If you do not wish to furnish the information, please check below.

Primary Applicant

I do not wish to furnish this information
Ethnicity Hispanic or Latino Not Hispanic or Latino

Race American Indian, Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White

Sex Male Female

Co-Applicant (if applicable)

I do not wish to furnish this information
Ethnicity Hispanic or Latino Not Hispanic or Latino

Race American Indian, Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White

Sex Male Female

Additional Information

How would you prefer to be contacted? Home Phone
Work Phone
Cell Phone
Email Address
Other
Please add me to your email list.

Special Instructions/Comments

Income verification is required; other information may be required.

I certify that statements on this application are true and complete. I authorize any person, association, firm or corporation to furnish, on request of this Financial Institution, information concerning me or my affairs.(Sec. 1014, Title 18, U.S. Code makes it a Federal Crime to knowingly make a false statement on this application.)