Express Home Mortgage

General Information

Purpose of Loan
Property will be
No. of Units
Year Built
Subject Property Address
Street
City, State, Zip
Property value	$
Approximate Annual Property Tax
Monthly Association Fees If Applicable?
If refinancing, do you escrow tax and Insurance?
If purchasing or refinancing do you want taxes and insurance escrowed?
Loan Amount	$
No. of Years
Loan Type
Interest Rate Expected	%
Funds available for down payment, closings costs and reserves^*
Source of Down Payment and Closing Costs

Please enter any comments or questions here:

Borrower Information

Please complete the below information for the borrower and co-borrower (if any).
	Borrower	Co-borrower
First Name & Middle Initial
Last Name
Social Security Number
Home Phone (incl. area code)
Business Phone (incl. area code)
E-mail address
Date of Birth

Please complete the below information for the borrower and co-borrower (if any).
	Borrower	Co-borrower
Present Address - Street
Present Address - City, State, Zip
Rent or Own?	No. of years	No. of years
If applicable, Current Monthly Rent Payment
* = Estimated
If residing at present address less than two years, please provide two year residence history.

Monthly Income Information

Gross Monthly Income	Borrower	Co-Borrower
Base Empl. Income*
Overtime
Bonuses
Commissions
Dividends/Interest
Net Rental Income
Other**

*Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.
**Notice: 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.

Employment Information
Current Employer Name
Position
Length of Employment
Time in Profession
Please provide two years of employment history.

Liquid Asset Information
	Borrower	Co-Borrower
Total Checking, Savings, CD's
Total Mutual Funds, Stocks, Bonds
Total IRA and Retirement Plan Assets

Liabilities
	Borrower
Provide Approximate Totals	Balances	Payments
Credit Cards
Installment Loans
Mortgages
	Co-Borrower
	Balances	Payments
Credit Cards
Installment Loans
Mortgages

Real Estate

If you own real estate in addition to the subject property, please provide address, approximate value and mortgage holder if any.

Declarations

		Borrower	Co-borrower
a.	Are there any outstanding judgments against you?
b.	Have you been declared bankrupt within the past 7 years?
c.	Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?
d.	Are you a party to a lawsuit?
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 (in space below), including date, name and address of Lender, FHA or VA case number, if any, and reasons for the action.)
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 (in space below) as described in the preceding question.
g.	Are you obligated to pay alimony, child support, or separate maintenance?
h.	Is any part of the down payment borrowed?
i.	Are you a co-maker or endorser on a note?
j.	Are you a U. S. citizen?
k.	Are you a permanent resident alien?
l.	Do you intend to occupy the property as your primary residence? If "Yes," complete question m below.
m.	Have you had an ownership interest in a property in the last three years?
m(1)	What type of property did you own-principal residence (PR), second home (SH), or investment property (IP)?
m(2)	How did you hold title to the home-solely by yourself (S), jointly with your spouse (SP), or jointly with another person (O)?

If you answered "yes" to any questions a through i, please explain below.

We authorize your company to check our credit, and verify any information stated on the loan application. We have read the fine print below.

The undersigned specifically acknowledge(s) and agree(s) that: (1) the loan requested by this application will be secured by a first mortgage or deed of trust on the property described herein; (2) the property will not be used for any illegal or prohibited purpose or use; (3) all statements made in this application are made for the purpose of obtaining the loan indicated herein; (4) occupation of the property will be as indicated above; (5) verification or reverification of any information contained in the application may be made at any time by the Lender, its agents, successors and assigns, either directly or through a credit reporting agency, from any source named in this application, and the original copy of this application will be retained by the Lender, even if the loan is not approved; (6) the Lender, its agents, successors and assigns will rely on the information contained in the application and I/we have a continuing obligation to amend and/or supplement the information provided in this application if any of the material facts which I/we have represented herein should change prior to closing; (7) in the event my/our payments on the loan indicated in this application become delinquent, the Lender, its agents, successors and assigns, may, in addition to all their other rights and remedies, report my/our name(s) and account information to a credit reporting agency; (8) ownership of the loan may be transferred to successor or assign of the Lender without notice to me and/or the administration of the loan account may be transferred to an agent, successor or assign of the Lender with prior notice to me; (9) the Lender, its agents, successors and assigns make no representations or warranties, express or implied, to the Borrower(s) regarding the property, the condition of the property, or the value of the property. Certification: I/We certify that the information provided in this application is true and correct as of the date set forth opposite my/our signature(s) on this application and acknowledge my/our understanding that any intentional or negligent misrepresentation(s) of the information contained in this application may result in civil liability and/or criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Section 1001, et seq. and liability for monetary damages to the Lender, its agents, successors and assigns, insurers and any other person who may suffer any loss due to reliance upon any misrepresentation which I/we have made on this application.

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Online Mortgage Application

General Information

Borrower Information

Monthly Income Information

Employment Information

Liquid Asset Information

Liabilities

Real Estate

Declarations