Loan Information
Product to finance:
Select a product
In-Ground Swimming Pool
Landscaping
Include debt consolidation?:
Select
Yes
No
Amount for home improvement:
Amount to Consolidate:
Terms Requested:
Select years
10 years
15 years
20 years
Contractor:
Applicant
Name:
DOB:
SS#:
Address:
City:
State:
Select state
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
D.C.
Delaware
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip:
County:
Previous
Residence:
(IF CURRENT RESIDENCE IS LESS THAN 2 YEARS)
Time at Previous Address:
(IF CURRENT IS LESS THAN 2 YEARS)
County of Previous Address:
Home
phone#:
Work
phone#:
Email Address:
Marital Status:
Married
Unmarried
Co-Applicant
Name:
DOB:
SS#:
Work
phone#:
Marital Status:
Married
Unmarried
Applicant Income Information:
Applicant's Employer:
Position:
Gross Mon.Income:
Years on job:
Previous Employer:
Time at Previous Employer:
(IF CURRENT EMPLOYER IS LESS THAN 3 YEARS)
Additional Income
Amount:
Source:
Co-Applicant Income Information:
CO-Applicants Employer:
Position:
Gross Mo. Income:
Years on job:
Previous Employer:
Time at Previous Employer:
(IF CURRENT EMPLOYER IS LESS THAN 3 YEARS)
Additional Income
Amount:
Source:
Residence Information:
Purchase Date:
Price Paid:
Current Value:
Mortgage balance:
Payments:
Lender:
Second Mortgage or Equity line of credit
Balance:
Payments:
Lender for Second Mortgage
Would you like to pay off your equity line or second, and include it in your homeimprovement?
Select
Yes
No
Is your home a mobile home?
Select
Yes
No
Authorization:
We hereby give our consent to and any Credit Reporting Bureau which they may designate, to obtain any and all information concerning our employment, checking and savings accounts, mortgage payments and all credit matters which they may require in processing our application for a loan and/or extenstion of credit. I/we certify that the information given is honest and accurate and without omission.
Applicant
Date
Co-Applicant
Date
Page 2 -- (Please include with application if faxing or mailing.)
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 withequal 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 neither discriminate on the basis of this information nor on whether you chose to furnish it. However, if you choose not to furnish it, under Federal regulations this lender is required to note race and sex on the basis of visual observations or surname. If you do not wish to furnish the below information please check the box appropriately. (Lender must review the material to assure that the disclosures satisfy all requirements to which the Lender is subject under applicable state law for the particular type of loan applied for.)
Applicant Ethnicity
Hispanic or Latino
Not Hispanic or Latino
American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Gender:
Female
Male
Applicant: I do not wish to provide this information (initials)
Co-Applicant Ethnicity
Hispanic or Latino
Not Hispanic or Latino
American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Gender:
Female
Male
Applicant: I do not wish to provide this information (initials)
Additional Comments
