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Uniform Residential Loan Application
Print All Four Pages and Mail or Fax to
6631 Commerce Parkway Suite N
Dublin, Ohio 43017
fax: 614-899-9190
Mortgage Broker Number: MB 802616 UI 219001
Please note that your printer's paper size must be set to Legal Paper (8 1/2" x 14")

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)

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