FIRST
APPLICANT:
First Name:
Middle
Initial:
Last
Name:
Social
Security #:
Birthday
(mm/dd/yy):
Application
Type:
-Select One-
Individual
Joint
Marriage Status:
-Select One-
Married
Unmarried
Separated
Phone:
Email
Address:
Driver's License
Number :
Driver's License
State:
Driver's License
Expiration :
Housing
Information
Present Address:
(Number,
Street, Apt. P.O. Box)
City:
County:
State:
Zip:
How
Long?
years
months
Previous Address:
(If
less than 5 years)
(Number,
Street, Apt. P.O. Box)
City:
County:
State:
Zip:
How
Long?
years
months
Employment
Information
Employer:
How
Long?
years
months
Employer
Phone:
Position:
Gross
Monthly Income:
Previous Employer:
(If
less than 2 years @ current)
How
Long?
years
months
Additional
Income Source:
Gross
Additional Income:
(monthly)
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 not discriminate on this information
, or on whether you choose to furnish
it. However, if you choose not to
furnish this information, under federal
regulations,, the lender is required to
note ethnicity and sex on the basis of
visual observation or surname. If
you do not which to furnish this
information please select that option.
Ethnicity
-Select One-
Decline to give this information
Hispanic or Latino
Not Hispanic or Latino
Race or National
Origin:
-Select One-
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Pacific Islander
White
Sex:
-Select One-
Male
Female
SECOND
APPLICANT:
First Name:
Middle
Initial:
Last
Name:
Social
Security #:
Birthday
(mm/dd/yy):
Daytime
Phone:
Email
Address:
Driver's License
Number :
Driver's License
State:
Driver's License
Expiration :
Second
Applicant Employment
Information
Employer:
How
Long?
years
months
Employer
Phone:
Position:
Gross
Monthly Income:
Previous Employer:
(If
less than 2 years @ current)
How
Long?
years
months
Additional
Income Source:
Gross
Additional Income:
(monthly)
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 not discriminate on this information
, or on whether you choose to furnish
it. However, if you choose not to
furnish this information, under federal
regulations,, the lender is required to
note ethnicity and sex on the basis of
visual observation or surname. If
you do not which to furnish this
information please select that option.
Ethnicity
-Select One-
Decline to give this information
Hispanic or Latino
Not Hispanic or Latino
Race or National
Origin:
-Select One-
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Pacific Islander
White
Sex:
-Select One-
Male
Female
PROPERTY TO BE IMPROVED:
Current Home Value:
Purchase
Date
(ex. mm/dd/yy):
Purchase
Price:
First
Lender:
Balance:
Monthly
Payment:
Second
Lender (if any):
Second
Balance:
Second
Monthly
Payment:
Last
Appraisal Amount:
Last
Refinance Date:
(if
applicable)
County:
Banking Reference:
Do you have a
Checking Account?
-Select One-
Yes
No
Savings Account?
-Select One-
Yes
No
WE
ARE REQUESTING FUNDS FOR: (select one)
Pool Builder
Name:
Contract Price:
$
Down Payment :
$
Amount
Requested:
$
Term :
months
Defer Payment:
None
30 Days
90 Days
180 Days
I certify
that I have read the information below.