Secure On-Line Application
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Year Acquired
Original Cost
Amount Existing Leins
Purpose of Refinance
Describe Improvements and Cost
Improvements are:already made to be made
Total Cost of Improvements

Part II. Borrower Information
BORROWER'S INFORMAION

Borrower's Name
Social Security Number
Home Phone (include area code)
Age
Years of School
Marital Status: Married Unmarried (include single, divorce, widowed) Separated
Number of Dependents Ages
Present Address (street,city,state,ZIP)

Do yourent or own the property?
Number of years at this residence

Please fill out this section if residing at present address for less than two years.
Previous Address
Present Address (street,city,state,ZIP)

Do yourent or own the property?
Number of years at this residence

Previous Address
Present Address (street,city,state,ZIP)

Do yourent or own the property?
Number of years at this residence

CO-BORROWER'S INFORMAION
Co-Borrower's Name
Social Security Number
Home Phone (include area code)
Age
Years of School
Marital Status: Married Unmarried (include single, divorce, widowed) Separated
Number of Dependents Ages
Present Address (street,city,state,ZIP)

Do yourent or own the property?
Number of years at this residence

Previous Address
Present Address (street,city,state,ZIP)

Do yourent or own the property?
Number of years at this residence

Part III. Employment Information
BORROWER'S EMPLOYMENT INFORMATION
Name and Address of Employer (indicate if self-employed)

Years on this job
Position/Title/Type of Business
Business Phone
Please fill out this section if employed at more than one position or employed at current position for less than two years.
Name and Address of Employer (indicate if self-employed)

Years on this job
Position/Title/Type of Business
Business Phone

Name and Address of Employer (indicate if self-employed)

Years on this job
Position/Title/Type of Business
Business Phone

CO-BORROWER'S EMPLOYMENT INFORMATION
Name and Address of Employer (indicate if self-employed)

Years on this job
Position/Title/Type of Business
Business Phone

Please fill out this section if employed at more than one position or employed at current position for less than two years.
Name and Address of Employer (indicate if self-employed)

Years on this job
Position/Title/Type of Business
Business Phone

Name and Address of Employer (indicate if self-employed)

Years on this job
Position/Title/Type of Business
Business Phone

Part IV. Monthly Income
BORROWER
Base Employment Income
Overtime
Bonuses
Commissions
Dividens/Interest
Net Rental Income
Other

Total Monthly Income

CO-BORROWER
Base Employment Income
Overtime
Bonuses
Commissions
Dividens/Interest
Net Rental Income
Other

Total Monthly Income

Part V. Assets and Liabilities

ASSETS

Name and Address of Bank, S&L, or Credit Union
Account #'s, Account Values

Name and Address of Bank, S&L, or Credit Union
Account #'s, Account Values

Name and Address of Bank, S&L, or Credit Union
Account #'s, Account Values

Total vested interest in retirement fund

Automobiles (year, make, and value)

Other Assets Items & Value (household items, clothing, jewelry, furniture)

TOTAL ASSETS

LIABILITIES

Name and Address of Company
Monthly Payment and Months Left to Pay
Net Unpaid Balance

Name and Address of Company
Monthly Payment and Months Left to Pay
Net Unpaid Balance

Name and Address of Company
Monthly Payment and Months Left to Pay
Net Unpaid Balance

SCHEDULE OF REAL ESTATE OWNED

Property Address and Status (sold, pending sale, rental, personal residence
Type of Property (house, apartment, etc.)
Present Market Value
Amount of Mortgage and Leins
Gross Rental Income
Mortgage Payments
Insurance, Maintenance, Taxes, Etc.
Net Rental Income

Property Address and Status (sold, pending sale, rental, personal residence
Type of Property (house, apartment, etc.)
Present Market Value
Amount of Mortgage and Leins
Gross Rental Income
Mortgage Payments
Insurance, Maintenance, Taxes, Etc.
Net Rental Income

Part VI. Declarations

Are there any outstanding judgements against you? No Yes
Have you been bankrupt within the past 7 years? No Yes
Have you had property foreclosed upon or given the title or deed in lieu thereof in the last 7 years? No Yes
Have you been directly or indirectly obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgement? No Yes
Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee? No Yes
Are you obligated to pay alimony, child support, or seperate maintenance? No Yes
Is any part of the down payment borrowed? No Yes
Are you a co-maker or endorser on a note? No Yes
If you answered "YES" to any of the above questions please explain below.

Are you a U.S. Citizen? No Yes
Are you a permanent resident alien? No Yes
Do you intend to ccupy the property as your permanent residence? No Yes
If Yes,
Have you had ownership interest in the property in the last three years? No Yes
If yes, please describe

Part VII. INFORMATION FOR GOVERNMENT MONITORING PURPOSES
The following information is requested by the Federal Government for certain types of loans related to 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 neither discriminate on the basis of this information, nor on whether you choose to furnish it. However, if you do not furnish it, under Federal regulations this Lender is required to note race and sex on the basis of individual observation or surname.

Please Mark Your Race/National Origin:
American Indian/Alaskan Native Asian/Pacific Islander White Black Hispanic

Mark hereif you choose not to furnish this information.

Part VIII. ACKNOWLEGEMENT AND AGREEMENT
By submitting this application you agree and acknowledge 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 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 have a continuing obligation to amend and/or supplement the information provided in this application if any of the material facts which I have represented should change prior to closing; 7) in the event my 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 name and account information to a credit reporting agency; 8) ownership of the loan may be transferred to a 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 regarding the property, Furthermore, I certify that the information provided in this application is true and correct as of the date submitted and acknowledge that any intentional or negligent misrepresentation 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 damges 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 have made in this application.