Mortgage Application

BASIC INFORMATION

Type Of Application

Authorization Type*

Amount Requested*

Reason for Loan*

Term of Mortgage*

(number of months)

Type of Property*

Property Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Current Mortgage Balance*

Annual Real Estate Taxes

PRIMARY APPLICANT

Member Number

Phone Number*

Date of Birth*

E-mail address*

Name*

First Name

Initial (optional)

Last Name

SSN*

Present Address (Do not use P.O. Box)*

Address Line 1

Address Line 2

City

State

ZIP Code

Driver's License Number*

Driver's License State Issued*

Driver's License Expiration Date*

Driver's License Issue Date*

If there's a Co-Applicant, please select the checkbox and complete the necessary fields.

Yes

CO-APPLICANT

Member Number

Phone Number*

Date of Birth*

E-mail address*

Name*

First Name

Initial

Last Name

SSN*

Present Address (Do not use P.O. Box)*

Address Line 1

Address Line 2

City

State

ZIP Code

Driver's License Number*

Driver's License State Issued*

Driver's License Expiration Date*

Driver's License Issued Date*

EMPLOYMENT - PRIMARY APPLICANT

Present Employer*

Position

Years*

Monthly Salary*

Source of other monthly income: Property, Investments, Social Security, CD's, etc.

Other Income

EMPLOYMENT - CO-APPLICANT

Present Employer

Position

Years*

Monthly Salary*

Source of other monthly income: Property, Investments, Social Security, CD's, etc.

Other Income

Credit Information

Installment (i.e. Auto Loan, Home Equity Loan, etc.)

Revolving (i.e. Credit Cards, Home Equity Line of Credit, etc.)

Other Obligations

SIGNATURES

By checking below, I authorize the credit union to obtain credit reports in connection with this request. Furthermore, I consent to receiving disclosures and documents via e-mail and to the use of “electronic records” and “electronic signatures” as the terms are defined in and governed by the applicable Federal and/or state electronic transaction laws.

Please check off the proper box(es) below before submitting this application

Applicant Acknowledgement*

X

Applicant Acknowledgement Date*

Co-Applicant Acknowledgement

X

Co-Applicant Acknowledgement Date