Additional Information

  • Any information not supplied on this online form

  • One full month of recent paycheck stubs for each borrower (ie, weekly = 4 pay stubs, biweekly = 3 pay stubs, semimonthly = 2 pay stubs)

  • Last two years' W-2 forms

  • Name of Banks and/or Financial Institutions

  • Copy of recent bank statements

  • Copy of Homeowner's Insurance Policy, "DECLARATIONS PAGE", for all properties, including agent's name and phone number.

  • Copy of Mortgage Statement or Coupon

  • FAIL (the browser should render some flash content, not this).
    Loan Purpose: Date:
    First Name: Middle: Last Name:
    Social Security #: Birth Date: (mm/dd/yy)
    E-mail: Best time/
    Place to Call:
    Home Phone:
    Work Phone:
    Other Phone:
    City: State:
    Type of Home: Home Value:

    Do you currently have a mortgage?
    Yes    No
    Do you have a second mortgage?
    Yes    No

    Have you ever declared bankruptcy?
    Yes    No

    Credit Rating: Credit Explanation:
    Position/Title:    Years at Job:
    Gross Salary:    Other Income:
    Referred By:   
    Is there or will there be a co-applicant?
    Yes    No

    I hereby authorize the Lender/Broker to verify my past and present employment earnings records, bank accounts, stock holdings, and my other asset balances that are needed to process my mortgage loan application. I further authorize the Lender/Broker to order a consumer credit report and verify other credit information, including past and present mortgage and landlord references. It is understood that a copy of this form will also serve as authorization.

    The information the Lender/Broker obtains is only to be used in the processing of my application for a mortgage loan.

    NMLS #1831812
    Equal Housing Lender
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