Member FDIC | Equal Housing Lender
Privacy Statement

Uniform Residential Loan Application
Submitter Information
First Name (required)
Last Name (required)
Resolve the errors marked in red before submitting again.
Name
Alternate Names
Social Security Number
Date of birth
Citizenship
Type of Credit
If applying for JOINT CREDIT, total number of borrowers
List Name(s) of Other Borrower(s) Applying for this Loan
First, Middle, Last, Suffix - one name per line.
First NameMiddle NameLast NameSuffixSocial Security NumberBirth Date
Co-Borrower 1
 
Co-Borrower 2
 
Co-Borrower 3
 
Co-Borrower 4
 
Co-Borrower 5
 
Marital Status
Select "Unmarried" for Single, Divorced, Civil Union, Domestic Partnership, or Registered Reciprocal Beneficiary Relationship status
Number of Dependents
Ages of Dependents
Contact Information
PhoneExtension
Home
 
Cell
 
Work
 
Contact Information
Email Address
 
Current Address
How Long at Current Address
YearsMonths

 
Housing
Current Address
No primary housing expense
 
Own
 
Rent
 
Monthly Housing Expense
If at Current Address for LESS than 2 years, list Former Address
How long at Former Address
YearsMonths

 
Housing
Former Address
No primary housing expense
 
Own
 
Rent
 
Monthly Housing Expense
Mailing Address
If different from Current Address
Employer or Business Name
Employer or Business Address
Employer or Business Phone Number
Position or Title
Start Date
How long in this line of work?
YearsMonths

 
Check if this statement applies
If Business Owner or Self Employed
check the appropriate option
Monthly Income (or Loss)
Gross Monthly Income
Base
 
Overtime
 
Bonus
 
Commission
 
Military Entitlements
 
Other
 
TOTAL
 
Employer or Business Name
Employer or Business Phone Number
Employer or Business Address
Position or Title
Start Date
How long in this line of work?
YearsMonths

 
Check if this statement applies
If Business Owner or Self-Employed
Gross Monthly Income
Base
 
Overtime
 
Bonus
 
Commission
 
Military Entitlements
 
Other
 
TOTAL
 
Employer or Business Name
Employer or Business Address
Position or Title
Start Date
End Date
Previous Gross Monthly Income
Use list above to identify the Income Source.
Income SourceMonthly Income

 

 

 

 

 
Provide TOTAL Monthly Amount Here
Use the list above to identify the Account Type.
Account TypeFinancial InstitutionAccount NumberCash or Market Value

 

 

 

 

 
Provide TOTAL Amount Here
Use list above to determine Asset or Credit Type
Asset or Credit TypeCash or Market Value

 

 

 

 

 
Provide TOTAL Amount Here
Use list above to determine Account Type
Account TypeCompany NameAccount NumberUnpaid BalanceTo be paid off at or before closing (yes or no)Monthly Payment

 

 

 

 

 
Type of Liability or ExpenseMonthly Payment

 

 

 

 
Property Address
Property ValueStatus: Sold, Pending Sale, or RetainedIntended Occupancy: Investment, Primary Residence, Second Home, OtherMonthly Insurance, Taxes, Association Dues, etc. If not included in Monthly Mortgage PaymentMonthly Rental Income(For LENDER to calculate) Net Monthly Rental Income

 
Mortgage Loans on this Property
Creditor NameAccount NumberMonthly Mortgage PaymentUnpaid BalanceTo be paid off at or before closingType: FHA, VA, Conventional, USDA-RD, OtherCredit Limit (if applicable)

 

 

 
Property Address
Property ValueStatus: Sold, Pending Sale, or RetainedIntended Occupancy: Investment, Primary Residence, Second Home, OtherMonthly Insurance, Taxes, Association Dues, etc. if not included in Monthly Mortgage PaymentMonthly Rental Income(For LENDER to calculate) Net Monthly Rental Income

 
Mortgage Loans on this Property
Creditor NameAccount NumberMonthly Mortgage PaymentUnpaid BalanceTo be paid off at or before closingType: FHA, VA, Conventional, USDA-RD, OtherCredit Limit (if applicable)

 

 

 
Property Address
Property ValueStatus: Sold, Pending Sale, or RetainedIntended Occupancy: Investment, Primary Residence, Second Home, OtherMonthly Insurance, Taxes, Association Dues, etc. if not included in Monthly Mortgage PaymentMonthly Rental Income(For LENDER to calculate) Net Monthly Rental Income

 
Mortgage Loans on this Property
Creditor NameAccount NumberMonthly Mortgage PaymentUnpaid BalanceTo be paid off at or before closingType: FHA, VA, Conventional, USDA-RD, OtherCredit Limit (if applicable)

 

 

 
Loan Amount
Loan Purpose
Property Address
Occupancy
Mixed-Use Property
If you will occupy the property, will you set aside space within the property to operate your own buisness? (e.g., daycare facility, medical office, beauty/barber shop)
Manufactured Home
Is the property a manufactured home? (e.g., a factory build dwelling built on a permanent chassis)
Creditor NameLien Type: First LienLien Type: Subordinate LienMonthly PaymentLoan Amount/Amount to be DrawnCredit Limit (if applicable)

 

 

 
Expected Monthly Rental Income
For LENDER to calculate: Expected Net Monthly Rental Income
Gifts or Grants
Use the list above to determine the Source.
Asset Type: Cash Gift, Gift of Equity, GrantDepositedNot DepositedSourceCash or Market Value

 

 

 
A. Will you occupy the property as your primary residence?
If YES, have you had an ownership interest in another property in the last three years?
If YES, complete (1) and (2) below
(1) What type of property did you own: Primary residence (PR), FHA secondary residence (SR), second home (SH), or investment property (IP)?
(2) How did you hold the title to the property: by yourself (S), jointly with your spouse (SP), or jointly with another person (O)?
B. If this is a Purchase Transaction: Do you have a family relationship or business affiliiation with the seller of the property?
C. Are you borrowing any money for this real estate transaction (e.g., money for your closing costs or down payment) or obtaining any money from another party, such as the seller or realtor, that you have not disclosed on this loan application?
If YES, what is the amount of this money?
D. 1. Have you or will you be applying for a mortgage loan on another property (not the property securing this loan) on or before closing this transaction that is not disclosed on this loan application?
D. 2. Have you or will you be applying for any new credit (e.g., installment loan, credit card, etc.) on or before closing this loan that is not disclosed on this application?
E. Will this property be subject to a lien that could take priority over the first mortgage lien, such as a clean energy lien paid through your property taxes (e.g., the Property Assessed Clean Energy Program)?
F. Are you a co-signer or guarantor on any debt or loan that is not disclosed on this application?
G. Are there any outstanding judgments against you?
H. Are your currently delinquent or in default on a Federal debt?
I. Are you party to a lawsuit in which you potentially have any personal financial liability?
J. Have you conveyed title to any property in lieu of foreclosure in the past 7 years?
K. Within the past 7 years, have you completed a pre-foreclosure sale or short sale, whereby the property was sold to a third party and the Lender agreed to accept less than the outstanding mortgage balance due?
L. Have you had property foreclosed upon in the last 7 years?
M. Have you declared bankruptcy within the past 7 years?
If YES, identify the type(s) of bankruptcy
Chapter 7Chapter 11Chapter 12Chapter 13

 
Borrower Signature
Name (First, Middle, Last, Suffix)Date
Borrower
 
Additional Borrower
 
Additional Borrower
 
Additional Borrower
 
Did you (or your deceased spouse) ever serve, or are you currently serving, in the United States Armed Forces?
If YES, check all that apply
If currently serving on active duty, projected expiration date of service/tour
Ethnicity
Check one or more
Sex
Race
If American Indian or Alaska Native, print name of enrolled or principal tribe
NOYES
Was the ethnicity of the Borrower collected on the basis of visual obervation or surname?
 
Was the sex of the Borrower collected on the basis of visual obervation or surname?
 
Was the race of the Borrower collected on the basis of visual obervation or surname?
 
The Demographic Information was provided through
Loan Originator Organization Name
Address
Loan Originator Organization NMLSR ID #
 
State License ID #
 
Loan Originator Name
 
Loan Originator NMLSR ID #
 
State License ID #
 
Email
 
Phone
 
Signature
Date