Uniform Residential Loan Application
This application is designed to be completed by the applicant(s) with
the lender's assistance. Applicants should complete this form as
"Borrower" or "Co-Borrower", as applicable.
Co-Borrower information must also be provided (and the appropriate box
checked) when the income or assets of a person other than the
"Borrower" (including the Borrower's spouse) will be used as
a basis for loan qualification or the income or assets of the
Borrower's spouse will not be used as a basis for loan qualification,
but his or her liabilities must be considered because the Borrower
resides in a community property state, the security property is
located in a community property state, or the Borrower is relying on
other property located in a community property state as a basis for
repayment of the loan.
| I.
TYPE OF MORTGAGE AND TERMS OF LOAN |
Mortgage 
V.A.
Conventional
Other:
Applied for: FHA
FmHA |
Agency Case #
|
Lender Case #
|
Amount
$ |
Interest Rate
% |
No. of Months
|
Amortization
Fixed Rate
Other (explain):
Type:
GPM ARM(type): |
| II.
PROPERTY INFORMATION AND PURPOSE OF LOAN |
Subject Property
Address (street , city, state,ZIP)
|
No. of Units
|
Legal Description
of Subject Property (attach description if necessary)
|
Year Built |
Purpose of Loan
Purchase
Construction
Other (explain):
Refinance
Construction-Permanent |
Property will be:
Primary
Residence Secondary
Residence
Investment |
| Complete this line if
construction or construction-permanent loan. |
Year Lot
Acquired |
Original Cost
$ |
Amount Existing Liens
$ |
(a) Present Value of Lot
$ |
(b) Cost of Improvements
$ |
Total (a+b)
$ |
| Complete this line if this is
a refinance loan. |
Year
Acquired |
Original Cost
$ |
Amount Existing Liens
$ |
Purpose of Refinance
|
Describe Improvements
made to be
made
Cost $ |
| Borrower
III. BORROWER INFORMATION
;
Co-Borrower |
Borrower's Name (include Jr. or
Sr. if applicable)
|
Co-Borrower's Name (include Jr.
or Sr. if applicable
|
Social Security #
|
Home Phone (incl. area code)
|
Age
|
Yrs. School
|
Social Security #
|
Home Phone (incl. area code)
|
Age
|
Yrs. School
|
Married
Unmarried
(include single divorced, widowed)
Separated |
Dependents
(not listed by Co- Borrower)
no. ![|]() ages |
Married
Unmarried
(include single divorced, widowed)
Separated |
Dependents
(not listed by Borrower)
no. ![|]() ages |
| If residing at present
address for less than two years, complete the following: |
Previous Address (street, city,
state, ZIP)
Own Rent
____No. Yrs.
|
Previous Address (street, city,
state, ZIP)
Own Rent
____No. Yrs.
|
Previous Address (street, city,
state, ZIP)
Own Rent
____No. Yrs.
|
Previous Address (street, city,
state, ZIP)
Own Rent
____No. Yrs..
|
| Borrower
IV.
EMPLOYMENT INFORMATION
Co-Borrower |
| Name
and Address of Employer
Self Employed (check above box) |
Yrs. on this job
|
Name
and Address of Employer
Self Employed (check above box) |
Yrs. on this job
|
Yrs. employed
in this line of
work/profession |
Yrs. employed
in this line of
work/profession |
| Position/Title/Type
of Business |
Business Phone
(incl. area code) |
Position/Title/Type
of Business |
Business Phone
(incl. area code) |
| If employed in current
position for less than two years or if currently employed in
more than one position, complete the following: |
Name
and Address of Employer
Self Employed (check above box)
|
Dates(from-to)
|
Name
and Address of Employer
Self Employed (check above box)
|
Dates(from-to)
|
Monthly Income
$ |
Monthly Income
$ |
| Position/Title/Type
of Business
|
Business Phone
(incl. area code)
|
Position/Title/Type
of Business
|
Business Phone
(incl. area code)
|
Name
and Address of Employer
Self Employed (check above box)
|
Dates(from-to)
|
Name
and Address of Employer
Self Employed (check above box)
|
Dates(from-to)
|
Monthly Income
$ |
Monthly Income
$ |
| Position/Title/Type
of Business |
Business Phone (incl. area
code) |
Position/Title/Type
of Business |
Business Phone (incl. area
code) |
|