Short Form Mortgage Application (Mini-1003) Page 1 of 2
DATE: ________________ TIME: _________________ LOAN OFFICER: _____________________________________________
PURPOSE OF LOAN: REFINANCE PURCHASE CONSTRUCTION EQUITY LINE
PRIMARY BORROWER: _______________________________ DOB: ____/____/19____ SSN: ______-____-________
PHONE (H): (______) ______-_________ PHONE (W): (______) ______-__________ PHONE (C): (______) ______-_________
CO-BORROWER: _____________________________________ DOB: ____/____/19____ 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: $ _______________
2
ND
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: __________________________________________________
_______________________________________________________________________________________________________
Y N
Y N
Y N
0.00%
MO YR
Short Form Mortgage Application (Mini-1003) Page 2 of 2
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, 2
nd
homes & land): _____________________________________________________
NOTES
:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
MO YR
Y N
Y N
Y N
Y N
Y N
