| 
			Secure Mortgage Application (651) 
			552-3681 | 
	
		| Borrower Basic Information |  * = 
		Required Information | 
	
		| Is there a 
		co-borrower? | No  Yes 
		-  If yes, co-borrower name If yes, co-borrower information can be entered on the next page
 but include their assets (checking/savings) on this page.
 
 | 
	
		| Your FULL Name (First, MI, 
		Last) * |  | 
	
		| Email address * | Required | 
	
		| Best Phone # * | Home or Cell 2nd best phone #   Home or Cell
 | 
	
		| Current 
		Address * | City  State  
		Zip | 
	
		| How long have you lived here | years  months | 
	
		| Do you currently |  | 
	
		| Old Address 
 | (if at current less than 2 
		years) Address  City State  Zip
 | 
	
		|  | Did you  How 
		long did you live there  years  months | 
	
		| Date of Birth (format mo/da/year) | Required | 
	
		| Social 
		Security Number | Required | 
	
		| Credit |  | 
	
		|  | Ever 
		File Bankruptcy?  If 
		Yes, How long discharged? Years | 
	
		| Marital Status |  | 
	
		| Years of Schooling |  | 
	
		| Any dependents? | No  Yes. 
		If yes, how many? . 
		Ages | 
	
		| Are you US Military? |  | 
	
		|  |  | 
	
		| Borrower 
		Employment |  | 
	
		| Employer |  | 
	
		| Address | City  State  Zip | 
	
		| Position/Title with Company |  | 
	
		| Time with Current Employer | Years  Months | 
	
		| How long in this line of work? | Years | 
	
		| Are you self employed? |  | 
	
		| Work Ph# | (REQUIRED for 
		verification of employment) | 
	
		| Previous Employer | (if 
		less than 2 years with current employer) Employer
 | 
	
		|  | Address  City State Zip | 
	
		|  | You worked 
		there from when to when mo 
		/yr 
		until mo 
		/ yr | 
	
		|  | Old Income , 
		per | 
	
		|  | Former Position/Title | 
	
		|  |  | 
	
		| 
		Contacting You | We usually attempt to 
		contact you between 10:00 AM & 6:00 PM Monday - Friday. If we are unable to contact you during this time frame, it could delay 
		your application.
 | 
	
		| Daytime Contact | at | 
	
		|  |  | 
	
		| Basic Loan 
		Information |  | 
	
		| Purpose of loan (Refi, 
		Purchase) |  | 
	
		| Type of Loan (Fixed, ARM, 
		FHA, etc) |  | 
	
		| Amortization 
		Term: | 6 
		yr - 30 yr available | 
	
		| Estimate Loan Amount Needed 
		$ |  | 
	
		| Property will be our |  | 
	
		| I applying today for |  | 
	
		| Estimated Closing Time |  | 
	
		|  |  | 
	
		| 
		Purchasing a home? | Answer these additional questions: (skip 
		if refinancing) | 
	
		| What is the Purchase Price? | (estimate 
		if pre-approval) | 
	
		| Down Payment % |  | 
	
		| Amount of Down Payment $ | .00 | 
	
		| Source of Down Payment: |  | 
	
		| Property Taxes on New Home? $ | (if 
		known) | 
	
		| Are you working with a 
		Realtor? | Yes, 
		info below  No 
		realtor yet  Please 
		refer a great one | 
	
		| Realtors Info: | Name | 
	
		|  | Ph#  Email | 
	
		|  |  | 
	
		| 
		Refinancing? | Answer the following additional 
		questions: (skip 
		if purchasing) | 
	
		| Your Current Monthly Payment 
		is: | $.  Does 
		this include escrows? YES   NO | 
	
		| Your Current Interest Rate? | %. 
		Current Mortgage Company Name? | 
	
		| Do you escrow for taxes & 
		Insurance? | YES NO | 
	
		| Who owns your 
		mortgage? | Check Fannie 
		Mae   Check Freddie 
		Mac | 
	
		| Current 
		Escrows: | Property Taxes $. 
		Homeowners Insurance $ (if 
		known) | 
	
		| About this 
		property? | Year 
		purchased? . 
		What was the original cost? $ | 
	
		| Today's Estimated Value $ |  | 
	
		| Estimated Remaining Balance 
		$ |  | 
	
		| Do you have 
		PMI on your loan? | YES NO | 
	
		| Have 
		a 2nd Mortgage/Equity Loan? | YES NO   
		- If yes, how much do you still owe? | 
	
		| Keep 
		or consolidate 2nd mortgage? | Keep Consolidate | 
	
		| How to pay closing 
		costs? |  | 
	
		|  |  | 
	
		| 
		Subject Property Information: | The Home you are buying or refinancing | 
	
		| Same as mailing address? | Yes 
		(refinance) | 
	
		| Found 
		property? | Yes 
		(address below)   No 
		- 
		(Still Looking) | 
	
		| Address: | City   State  Zip | 
	
		| : | (we lend in MN, WI, and SD only) | 
	
		| Monthly 
		Income: | Gross Monthly Income (Pre-Tax) | 
	
		| Base Income $ | per | 
	
		| Overtime |  | 
	
		| Bonuses |  | 
	
		| Commissions |  | 
	
		| Dividends/Interest |  | 
	
		| Net Rental Income |  | 
	
		| Other | (Child 
		Support, Social Security, Pension, etc) | 
	
		|  | Explain Income | 
	
		|  |  | 
	
		| 
		Current Housing Costs: |  | 
	
		| Rent |  | 
	
		| First Mortgage Payment (P/I) | Hazard 
		Insurance  Property 
		Taxes | 
	
		|  | PMI  Homeowner 
		Assn. Dues | 
	
		| Second Mortgage Payment 
		(P/I) |  | 
	
		|  |  | 
	
		| 
		Assets: (Include all 
		Applicants) | (includes checking, savings, 
		stocks, mutual funds, etc.) (Include 
		all Applicants Assets) | 
	
		| Account 1 | $ Name 
		of Bank | 
	
		| Account 2 | $ Name 
		of Bank | 
	
		| Account 3 | $ Name 
		of Bank | 
	
		| All additional accounts | $ | 
	
		| Stocks and Bonds | $ Name 
		of Bank | 
	
		| 401(k)/Retirement | $ | 
	
		| Net Worth of Businesses 
		Owned | $ | 
	
		| Automobiles Owned 1 | Yr/Make. 
		Estimated Value $ | 
	
		| Automobiles Owned 2 | Yr/Make. 
		Estimated Value $ | 
	
		|  |  | 
	
		| Liabilities: | Who do you owe? (Include 
		all Applicants debts) | 
	
		| Current 1st Mortgage Co or Landlord Name
 | . 
		Monthly payment | 
	
		| Current 2nd Mortgage Co | . 
		Monthly payment | 
	
		| 
		Alimony/Child Support | $ | 
	
		| All other debts of ALL applicants (car loans, credit cards, 
		student loans, etc) | List only 
		minimum required monthly payments $month.  
		Total unpaid balance(s) $
 | 
	
		|  |  | 
	
		| Own 
		Other Properties: |  | 
	
		| Own 
		any other property | NO YES | 
	
		| If "Yes" - What is it worth? | $ How 
		much do you owe on it? $ | 
	
		| What is the 
		payment? | $ | 
	
		| First other 
		property address | City St  Zip | 
	
		| Second other 
		property address | City St  Zip | 
	
		|  |  | 
	
		| 
		Declarations: |  | 
	
		|  | A. 
		Are there any outstanding judgments against you? | 
	
		|  | B. 
		Have you been declared bankrupt within the past 7 years? | 
	
		|  | C. Have 
		you had property foreclosed upon or given title or deed in lieu thereof 
		in the last 7 years? | 
	
		|  | D. Are 
		you a party to a lawsuit? | 
	
		|  | E. Have 
		you directly or indirectly been obliged on any loan which resulted in 
		foreclosure, transfer of title in lieu of foreclosure or judgment? | 
	
		|  | F. Are 
		you presently delinquent or in default on any Federal debt or any other 
		loan, mortgage, financial obligation, bond, or loan guarantee? | 
	
		|  | G. Are 
		you obligated to pay alimony, 
		child support, or separate maintenance? | 
	
		|  | H. Is 
		any part of the down payment borrowed? | 
	
		|  | I. Are 
		you a co-maker or endorser on a note? | 
	
		|  | J. Are 
		you a U.S. citizen? | 
	
		|  | K. Are 
		you a permanent resident alien? | 
	
		|  | l. Do 
		you intend to occupy the property as your primary residence? | 
	
		|  | M. Have 
		you had an ownership interest in a property in the last three years? | 
	
		|  | (1.) What 
		type of property did you own Principle residence (PR), second home (SH), 
		or investment property (IP)? | 
	
		|  | (2.) How 
		did you hold title to the home - solely by yourself (S), jointly with 
		your spouse (SP), or jointly with another person (O)? | 
	
		|  |  | 
	
		| 
		Government: | Information for Government Lender Monitoring purposes | 
	
		| I 
		do not wish to answer |  | 
	
		| Race |  | 
	
		| Ethnicity: | NOT Hispanic 
		or Latino Hispanic 
		or Latino
 | 
	
		| Gender | Male   Female | 
	
		|  |  | 
	
		| Other 
		Information: | Please write in any other 
		information you feel is important to us making our decision, or answers 
		to any YES questions in the declarations section. | 
	
		|  |  | 
	
		| How did you find out about 
		us | This help's keep our advertising dollar effective, therefore reducing YOUR closing 
		costs! | 
	
		|  |  | 
	
		| Finish: |  | 
	
		| 
		 | 
	
		|   
		
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