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  Short Form Mortgage Application (Mini-1003)  
  DATE: TIME: LOAN OFFICER:
PURPOSE OF LOAN: REFINANCE PURCHASE CONSTRUCTION EQUITY LINE
PRIMARY BORROWER: DOB: / / SSN:
PHONE (H): PHONE (W): PHONE (C):
CO-BORROWER: DOB: / / SSN:
PHONE (H): PHONE (W): PHONE (C):
CURRENT ADDRESS:
House No.                Street                City                State                Zip
  
  FOR PURCHASE (LISTED HOME):

HOME TYPE: SINGLE FAMILY DUPLEX MULTIPLEX TOWNHOME  CONDO
EST. MARKET VALUE: $
HOME ADDRESS:
House No.                 Street                 City                 State                 Zip
  
  FOR REFINANCE:

HOME TYPE: SINGLE FAMILY DUPLEX MULTIPLEX TOWNHOME CONDO
CASH OUT: Y N AMOUNT: $ REASON(S) FOR CASH:
EST MARKET VALUE OF HOME: $ TAX VALUE: $
YEAR PURCHASED: YEAR BUILT: ORIGINAL COST: $
HOW LONG IN HOME? ESCROW: Y N   MORTGAGE INS: Y N   AMT PER MO: $
CURRENT MORTGAGE HOLDER: MTG TYPE:
INTEREST RATE: TERM: YRS LEFT: BALANCE: $ MO PMT: $
2ND MORTGAGE/LINE OF CREDIT HOLDER: MTG TYPE:
INTEREST RATE: TERM: YRS LEFT: BALANCE: $ MO PMT: $
 
  EMPLOYMENT HISTORY: (BORROWER)

EMPLOYER NAME:
EMPLOYER ADDRESS:
POSITION/TITLE: YRS ON JOB:
GROSS INCOME: $ MO YR PAID ON: W-2 1099 SELF EMPL
PREVIOUS EMPLOYER/PART TIME EMPLOYMENT INFO:
 
  EMPLOYMENT HISTORY: (CO-BORROWER)

EMPLOYER NAME:
EMPLOYER ADDRESS:
POSITION/TITLE: YRS ON JOB:
GROSS INCOME: $ MO YR PAID ON: W-2 1099 SELF EMPL
PREVIOUS EMPLOYER/PART TIME EMPLOYMENT INFO:
 
  REVOLVING DEBT / MONTHLY OBLIGATIONS:

Majority of this information will be obtained via the credit report.
DO YOU PAY CHILD SUPPORT OR ALIMONY?: Y N                  AMOUNT/MO: $
REAL ESTATE TAXES: Y N   YEARLY: $ MO (IF KNOWN): $
HOME INSURANCE: Y N   YEARLY: $ MO (IF KNOWN): $
CREDIT HISTORY: EXCELLENT GOOD AVERAGE CHALLENGED
AGREE TO CREDIT CHECK: Y / N DATE: TIME: SCORE:
HAVE YOU HAD ANY LATE PAYMENTS ON YOUR MORTGAGE (PAST 12 MO) Y N
DESCRIBE CREDIT ISSUES (JUDGEMENTS, BANKRUPTCY, COLLECTIONS):
 
  ASSETS:

CASH IN BANK ACCOUNTS (include savings & checking):
INVESTMENTS (including 401K, brokerage accounts, stocks, bonds Etc…):
PROPERTY (including rental units, cabins, 2nd homes & land):
NOTES:







     
   
     
 
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