Uniform Residential Loan Application

I. Type of Mortgage and Terms of Loan

1. Mortgage Applied For:
    V.A.
    FHA
    Conventional
    USDA/Rural Housing Service
    Other:

2. Amount (e.g. 155,000)

3. Interest Rate (e.g. 5.50)

4. Number of Months (e.g. 360)

II. Property Information and Purpose of Loan

5. Property Address
    Street   
    City State Zip

6. Purpose of Loan:
    Purchase
    Refinance
    Construction-Permanent
    Other:

7. Property will be:
    Primary Residence
    Secondary Residence
    Investment

8. Source of Downpayment:

III. Borrower Information

BORROWER

9. Borrower's Name:
    First Name   Middle Initial   Last Name
    Jr.       Sr.   Other : (e.g. III, IV, etc.)    

10. Home Phone (include area code)     (e.g. 123-123-1234)

11. Date of Birth (MM/DD/YYYY)

12. Marital Status:
    Married
    Separated
    Unmarried (include single, divorced, widowed)

13. Dependents (not listed by Co-Borrower)
    Number Ages (separate by commas, e.g. 2,4,5,8)

14. Present Address:
    Street
    City State Zip

15. Mailing Address (if different from Present Address):
    Street
    City State Zip

16. If residing at present address for less than two years, complete the following:
    16a. Former Address:
    Street
    City State Zip

    16b. Own       Rent

    16c. Number of Years

CO-BORROWER

17. Co-Borrower's Name:
    First Name       Middle Initial

    Last Name     Jr.     Sr.    Other:

18. Home Phone (include area code)     (e.g. 123-123-1234)

19. Date of Birth (MM/DD/YYYY)

20. Marital Status:
    Married
    Separated
    Unmarried (include single, divorced, widowed)

21. Dependents (not listed by Co-Borrower)
    Number Ages (separate by commas, e.g. 2,4,5,8)

22. Present Address:
    Street
    City State Zip

23. Mailing Address (if different from Present Address):
    Street
    City State Zip

24. If residing at present address for less than two years, complete the following:
    24a. Former Address:
    Street
    City State Zip

    24b. Own       Rent

    24c. Number of Years

IV. Employment Information

BORROWER

25. Name & Address of Employer:       Self-Employed
    Name
    Street
    City State Zip

26. Position/Title/Type of Business

27. Years on this Job

28. Years employed in this line of work/profession

29. Business Phone (include area code)    (e.g. 123-123-1234)

If employed in current position for less than two years or if currently employed in more than one position, complete the following:

30. Name & Address of Employer:       Self-Employed
    Name
    Street
    City State Zip

31. Position/Title/Type of Business

32. Dates: from to (e.g. 04/2001)

33. Monthly Income $ (whole dollar amounts)

34. Business Phone (include area code)     (e.g. 123-123-1234)

CO-BORROWER

35. Name & Address of Employer:       Self-Employed
    Name
    Street
    City State Zip

36. Position/Title/Type of Business

37. Years on this Job

38. Years employed in this line of work/profession

39. Business Phone (include area code)     (e.g. 123-123-1234)

If employed in current position for less than two years or if currently employed in more than one position, complete the following:

40. Name & Address of Employer:       Self-Employed
    Name
    Street
    City State Zip

41. Position/Title/Type of Business

42. Dates: from to (e.g. 04/2001)

43. Monthly Income $ (whole dollar amounts)

44. Business Phone (include area code)      (e.g. 123-123-1234)

V. Gross Monthly Income & Combined Housing Expense Information

45. Gross Monthly Income: $ (whole dollar amounts)

46. Present Rent Amount: $ (whole dollar amounts)

VI. Assets and Liabilities

47. Assets: $ (balance of checking &/or savings accounts in whole dollar amounts)

48. Stocks & Bonds
    Company Name

    Phone (include area code)     (e.g. 123-123-1234)

    Description:

    $ (whole dollar amounts)

49. Life insurance net cash value:    Face amount $ (whole dollar amounts)

50. Value of Automobiles owned: $ (whole dollar amounts)

51. Other Assets/Personal Property (e.g. dishes, lawn mower, etc.) $ (whole dollar amounts)

52. Do you own any other property?

    52a. Yes    No

    52b. If yes, what is present market value? $ (whole dollar amounts)