Purchase 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 *  
  State  Zip  
How long have you lived here  years  months
Do you currently
Old Address
(if at current less than 2 years)
  State  Zip
  Did you 
  How long did you live there  years  months
Date of Birth (format mo/da/year)  Required
Social Security Number  Required
Marital Status
Years of Schooling
Any dependents?  No  Yes
   If yes, how many? . Ages 
Are you US Military?
Your Credit
Estimated  Score  
  Ever File Bankruptcy?  
  If Yes, How long discharged?  Years
  Ever have a Foreclosure?
  If Yes, How long long ago?  Years

Borrower Employment

  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)
  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

Type of Loan 
Amortization Term:  10-yr to 30-yr available
Property will be our
I applying today for
Estimated Closing Time
What is the Purchase Price?  (estimate if pre-approval)
Down Payment %
Exact down payment if known $.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 one
Realtors Info: Name  
  Ph#  Email

Exact Property Address - If known

  State  Zip (we lend in MN, WI, IA, ND, SD only)


YOUR Monthly Income: Gross Monthly Income (Pre-Tax)

Base Income $  per 
Net Rental Income
Other  (Child Support, Social Security, Pension, etc)
  Explain "other" Income 

Current Housing Costs:

Rent $
First Mortgage Payment $  Assn. Dues $
Second Mortgage Payment $
Current home? Plan on selling   Plan on keeping

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 $

Liabilities: Who do you owe?

Current 1st Mtg Co
 or Landlord Name
  Monthly payment $
Current 2nd Mtg Co .
  Monthly payment $

Alimony/Child Support

All other debts of ALL applicants (car loans, credit cards, student loans, etc) List best guess of only minimum required monthly payments
$ month. 
  Total unpaid balance(s) $ (best guess)

Own Other Properties?:

Other properties? If yes, answer following questions
1st property address  
  St  Zip
2nd home or rental Rental   2nd Home
What is rent? $ (if rental)
2nd property address  
  St  Zip
2nd home or rental Rental   2nd Home
What is rent $ (if rental)


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-signor 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

 I do not wish to answer
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, or you need to explain, 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!




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