Online Application Form

I. Type of Mortgage and Terms of Loan
Loan Amount: $
Years:
Preferred Loan Type(s):
Fixed Rate
15 year fixed
30 year fixed
Homeowner's Insurance:
Agent Name:
  Agent Phone:
II. Property Information and Purpose of Loan
Subject Property Address:
City, State, Zip:
Purpose of Loan:
 Purchase Refinance
Year Acquired
(if Refinance Loan):
Original Cost: $
Property Ownership:
Are you requesting "cash out" from this transaction ?
 Yes No
If so, how much?
Do you want to include your property taxes and homeowners insurance in with
the mortgage payment (requires 20% equity and a 25% fee charge) ?
 Yes No
Rate is floating until all loan criteria is met.
III. Borrower Information
Borrower
Co-Borrower
Borrower's Name:
Co-Borrower's Name:
Social Security Number:
Social Security Number:
Home Phone:
Home Phone:
DOB:
DOB:
Married Unmarried
  
IV. Employment Information
Borrower
Co-Borrower

Employer:
Self-employed (25% or more owner of a business)

Employer:
Self-employed  (25% or more owner of a business)
Employer Address (Street, City, State, Zip):
Employer Address (Street, City, State, Zip):
Years at current job:
Years at current job:
Position/Title/Type of Business:
Position/Title/Type of Business:
Business Phone:
Business Phone:
V. Monthly Income and Combined Housing Expense Information
Gross Monthly Income
Borrower
Co-Borrower
  
Base Employee Income:
 
Other Income:
 
Total:
 
VI. Assets and Liabilities
Assets
Liabilities
Bank, S&L, or Credit Union Name:
Mortgage Holder:
Address:
Account Number:
Account Balance:
$ Payment/Month:
   
Unpaid Balance:
Stock & Bonds/401k:
(Company name, number, description)
Do you have a second mortgage/home equity loan ?
Yes No
Cash or Market Value:
If yes do you want to combine it with your first mortgage ?
 Yes No
       
Real Estate owned:
(enter market value from schedule)
    
Total Assets:
Total Liabilities:
VII. Declarations
 
Borrower
Co-Borrower
a. Are there any outstanding judgements against you?
Yes No
Yes No
b. Have you been declared bankrupt within the past 7 years?
Yes No
Yes No
c. Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?
Yes No
Yes No
d. Are you a party to a lawsuit?
Yes No
Yes No
e. Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgement? (This would include such loans as home mortgage loans, SBA loans, home improvement loans, educational loans, manufactured (mobile) home loans, any mortgage, financial obligation, bond, or loan guarantee.)
Yes No
Yes No
f. Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee?
Yes No
Yes No
g. Are you obligated to pay alimony, child support, or separate maintenance?
Yes No
Yes No
h. Is any part of the down payment borrowed?
Yes No
Yes No
i. Are you a co-maker or endorser on a note?
Yes No
Yes No
j. Are you a U.S. citizen?
Yes No
Yes No
k. Are you a permanent resident alien?
Yes No
Yes No
l. Do you intend to occupy the property as your primary residence? If yes, complete question m.
Yes No
Yes No

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)?
Yes No
Yes No

VIII. Acknowledgement and Agreement
The undersigned specifically acknowledge(s) and agree(s) 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 purpose or 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/we have a continuing obligation to amend and/or supplement the information provided in this application if any of the material facts which I/we have represented herein should change prior to closing; (7) in the event my/our 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/our name(s) and account information to a credit reporting agency; (8) ownership of the loan may be transferred to 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(s) regarding the property, the condition of the property, or the value of the property.
Right to Receive Copy of Appraisal. I/We have the right to a copy of the appraisal report used in connection with this application for credit. To obtain a copy, I/we must send the Lender a written request at the mailing address Lender has provided. Lender must hear from me/us no later than 90 days after Lender notifies me/us about the action taken on this application, or I/we withdraw this application.
Certification: I/We certify that the information provided in this application is true and correct as of the date set forth opposite my/our signature(s) on this application and acknowledge my/our understanding that any intentional or negligent misrepresentation(s) 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 damages 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/we have made on this application.
Borrower's Signature: Co-Borrower's Signature:
IX. Information for Government Monitoring Purposes
Borrower
Co-Borrower
I do not wish to furnish this information I do not wish to furnish this information
Race:
Race:
If Other:
If Other:
Sex:
Sex:
       
Online User Information
I verify that the information included in this application is valid, and understand that the information included will be sent to Fortune Financial Corporation for the purposes specified above.
Name: Email:
Submit this form to your loan officer: