Mortgage Pre-Qualification Application
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First Name (required)
Last Name (required)
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Mortgage Pre Qual Application

NMLS# 799643

Privacy Policy: Our privacy policy protects the privacy of your personal-identifying information that you provide us online.

Account Holders must reside in New York state.

Important Information about Procedures for Opening a New Account

Identification Procedures Requirements: 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: When you open an account, 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.

Security Notice:
You should ONLY fill out this Application online if you are using a browser with the latest security enhancements. If you don't have the latest version, download a copy now.

Instructions:
1. Complete Application and click "Submit Application" or fax it to 315-638-9871.
2. To safeguard your privacy, QUIT your browser and restart it again after using this form. This form is NOT saved in your computer's memory when you quit your browser.
3. We will contact you with the location of our closest office and any other documentary requests we may have. You may also be requested to provide photocopies of your Driver's License or other identification.

This Residential Loan Application is for personal loans and is NOT intended for Business use.

This application is designed to be completed by the applicant(s) with the Lender's assistance. 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 Borrower's spouse) will be used as a basis for loan qualification or the income or assets of the Borrower's spouse will not be used as a basis for loan qualification, but his or her liabilities must be considered because 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.

Uniform Residential Loan Application
If you are applying for a joint account or an account that you and another person will use, complete all sections, providing information about the Joint Applicant or user.
I. TYPE OF MORTGAGE AND TERMS OF LOAN
Mortgage Qualifying for:
Agency Case No.Lender Case No.Amount $Interest Rate %No. of Months

 

 
(required)
 

 
Amortization Type: (required)
II. PROPERTY INFORMATION AND PURPOSE OF LOAN - TBD AFTER QUALIFYING
Subject Property Address (street, city state & ZIP)No. of Units

 

 
Legal Description of Subject Property (attach description if necessary)Year Built

 

 
Purpose of Loan:
Property will be:
Complete these lines if construction or construction-permanent loan:
Year Lot AcquiredOriginal Cost $Amount Existing Liens $

 

 

 
(a) Present Value of Lot(b) Cost of Improvements $ Total (a+b) $

 

 

 
Complete these lines if this is a refinance loan.
Year AcquiredOriginal Cost $Amount Existing Liens $Purpose of Refinance

 

 

 

 
Describe Improvements
Describe ImprovementsCost $

 

 
Title will be held in what Names(s)Manner in which Title will be held:Source of Down Payment, Settlement Changes and/or Subordinate Financing (explain)

 

 

 
Estate will be held in:
III. BORROWER INFORMATION
Borrower
Borrower's Name (include Jr. or Sr. if applicable)Social Security No.Home Phone (incl. area code)Date of BirthYrs. School
(required) (required) (required) (required)
 
Dependents not listed by Co-Borrower
no.ages

 

 
Present Address
No. Yrs.
Former Address
If residing at present address for less than two years, complete the following:
No. of yrs.
Former Address
No. of yrs.
Co-Borrower
Co-Borrower's Name (include Jr. or Sr. if applicable)Social Security No.Home Phone (incl. area code)Date of BirthYrs. School

 

 

 

 

 
Dependents not listed by Borrower
no.ages

 

 
Present Address
No. Yrs.
Former Address
If residing at present address for less than two years, complete the following:
No. of yrs.
Former Address
No. of yrs.
IV. EMPLOYMENT INFORMATION
Borrower
Borrower
Name & Address of Employer Years on this jobYrs. employed in this line of work/profession:Position/Title/Type of BusinessBusiness Phone (include area code)
(required) (required)
 
(required) (required)

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

Name & Address of EmployerDates (from-to)Monthly income: $Position/Title/Type of BusinessBusiness Phone (incl. area code)

 

 

 

 

 
Name & Address of EmployerDates (from-to)Monthly income: $ Position/Title/Type of BusinessBusiness Phone (incl. area code)

 

 

 

 

 
Co-Borrower
Co-Borrower
Name & Address of EmployerYears on this jobYears employed in this line of work/profession:Position/Title/Type of BusinessBusiness Phone (incl. area code)

 

 

 

 

 

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

Name & Address of EmployerDates: from-to:Monthly income: $Position/Title/ Type of BusinessBusiness Phone (inc. area code)

 

 

 

 

 
Name & Address of EmployerDates: from-to:Monthly income: $Position/Title/ Type of BusinessBusiness Phone (inc. area code)

 

 

 

 

 
V. MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION
Gross Monthly Income
BorrowerCo BorrowerTotal
Base Empl. Income * (required)
 

 
Overtime
 

 

 
Bonuses
 

 

 
Commissions
 

 

 
Dividends/Interest
 

 

 
Net Rental Income
 

 

 
Other (before completing, see the notice in "describe other income" below)
 

 

 
Total (required)
 

 
Combined Monthly Housing Expense
PresentProposed
Rent
 

 
First Mortgage (P & I)
 

 
Other Financing(P & I)
 

 
Hazard Insurance
 

 
Real Estate Taxes
 

 
Mortgage Insurance
 

 
Homeowner Assn. Dues
 

 
Other
 

 
Total
 

 
* Self Employed Borrowers may be required to provide additional documentation such as tax returns and financial statements.
Describe Other Income B/CNotice: Alimony, child support, or separate maintenance income need not be revealed if the Borrower (B) or co-Borrower(C) does not choose to have it considered for repaying this loan.Monthly Amount
B/C
 

 

 
B/C
 

 

 
B/C
 

 

 
VI. ASSETS AND LIABILITIES

This Statement and any applicable supporting schedule 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 was completed about a spouse, this Statement and supporting schedules must be completed about that spouse also. 

Completed
ASSETS Description
Cash deposit toward purchase held by:Cash or Market Value
(required) (required)
List checking and savings accounts below
Name and address of Bank, S & L, or Credit Union Acct. no.Cash or Market Value
(required) (required) (required)

 

 

 

 

 

 

 

 

 

 

 

 
Stock & Bonds (Company name/number & description)Cash or Market Value

 

 
Life Insurance net cash value Face amount: $ Market Value

 

 
Real estate owned enter market value from schedule of real estate owned
Subtotal Liquid Assets
Real estate owned enter market value from schedule of real estate owned
Vested interest in retirement
Net worth of businesses owned attach financial statement
Automobiles owned (make and year)Cash or Market Value

 

 
Other Assets (itemized)Cash or Market Value

 

 
Cash or Market Value
Total Assets (a)
 

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.

Liabilities
Name and Address of CompanyMonthly Pmt. & Mos. Left to PayUnpaid BalanceAcct. No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
Monthly Pmt. & Mos. Left to Pay
Alimony/Child Support/Separate Maintenance Payments Owed to:
 
Monthly Pmt. & Mos. Left to Pay
Job Related Expense (child care, union dues, etc.)
 
Monthly Pmt. & Mos. Left to Pay
Total Monthly Payments
 
Monthly Pmt. & Mos. Left to Pay
Net Worth (a minus b)
 
Monthly Pmt. & Mos. Left to Pay
Total Liabilities(b)
 
VI. ASSETS AND LIABILITIES(cont.)
Schedule of Real Estate Owned if additional properties are owned use continuation sheet
Property AddressS - sold, PS- pending sale or R - rental being held for incomeType of PropertyPresent Market ValueAmount of Mortgage & LiensGross Rental IncomeMortgage PaymentsInsurance Maintenance, Taxes & Misc.Net Rental Income

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
Total
 

 

 

 

 

 

 

 

 
List any additional names under which credit has previously been received and indicate appropriate creditor names and account numbers:
Alternative NameCreditor Name Account Number

 

 

 
VII. DETAILS OF TRANSACTION
a. Purchase Price
b. Alterations, improvements, repairs
c. Land if acquired separately
d. Refinance incl. in debts to be paid off
e. Estimated prepaid items
f. Estimated closing costs
g. PMI, MIP, Funding Fee
h. Discount if Borrower will pay
i. Total costs add items a through h
j. Subordinate financing
k. Borrowers closing costs paid by Seller
l. Other Credits (explain)$

 

 
m. Loan amount exclude PMI, MIP, Funding Fee financed
n. PMI, MIP, Funding Fee financed
o. Loan amount add m & n
p. Cash from/to Borrower subtract j, k, l & o from i
VIII. DECLARATIONS
a. Are there any outstanding judgments against you?
YesNo
Borrower (required) (required)
Co-Borrower (required) (required)
b. Have you been declared bankrupt within the past 7 years?
YesNo
Borrower (required) (required)
Co-Borrower (required) (required)
c. Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?
YesNo
Borrower (required) (required)
Co-Borrower (required) (required)
d. Are you a party to a lawsuit?
YesNo
Borrower (required) (required)
Co-Borrower (required) (required)
e. Have you directly or indirectly been obligated on any loan 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.
YesNo
Borrower (required) (required)
Co-Borrower (required) (required)
f. Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee? If Yes, give details as described in the preceding question.
YesNo
Borrower (required) (required)
Co-Borrower (required) (required)
g. Are you obligated to pay alimony, child support or separate maintenance?
YesNo
Borrower (required) (required)
Co-Borrower (required) (required)
h. Is any part of the down payment borrowed?
YesNo
Borrower (required) (required)
Co-Borrower (required) (required)
i. Are you a co-maker or endorser on a note?
YesNo
Borrower (required) (required)
Co-Borrower (required) (required)
j. Are you a U.S. citizen?
YesNo
Borrower (required) (required)
Co-Borrower (required) (required)
k. Are you a permanent resident alien?
YesNo
Borrower (required) (required)
Co-Borrower (required) (required)
l. Do you intend to occupy the property as your primary residence? If Yes, complete question below.
YesNo
Borrower (required) (required)
Co-Borrower (required) (required)
m. Have you had an ownership interest in a property in the last two years?
YesNo
Borrower (required) (required)
Co-Borrower (required) (required)
1 What type of property did you own -- principal residence PR, second home SH, or Investment Property IP? (required)
2 How did you hold title to the home -- solely by yourself S, jointly with your spouse SP, or jointly with another person O? (required)
IX. 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 set forth opposite my signature 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 herein;

(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 herein;

(6) any owner or servicer of the Loan may verify or reverify any information contained in the application from any source named in this application, and Lender, its successors or assigns may retain the original and/or an electronic record of this application, even if the Loan is not 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 owner or servicer of the Loan 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 credit 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 fascimile 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.

Borrower's NameDateCo-Borrower's NameDate

 

 

 

 
X. 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 discriminate neither on the basis of this information, nor 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 or surname. 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:
Race or National Origin:
Sex
Co-Borrower:
Ethnicity
Race or National Origin:
Sex
To be completed by Interviewer (if applicable)
This application was taken by:
Interviewer's NameInterviewer's Phone Number (incl. area code)Name and address of Interviewer's Employer