PERSONAL INFORMATION

Borrower Information

First Name
Last Name
Middle Initial
Social Security #
Birthdate	MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Year 1925 1926 1927 1928 1929 1930 19311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989 Day 12345678910111213141516171819202122232425262728293031
Telephone Number
Current Address
City
State
Zip Code
Dates lived here From
To
Do you currently	Select OneRentOwnOwnLive with familyOther (please specify in comments)
E-Mail Address
Best method to contact you	Select OneHome PhoneWork PhoneCell Phone (put cell phone # in comments section)E-Mail
Best time to call/contact you
Please grade your credit	Select OneExcellentGoodOkaySome Late PaymentsLots of Lates/CollectionsDog-UglyOther (please specify in comments)

co-borrower information

First Name
Last Name
Middle Initial
Social Security #
Birthdate
Telephone Number
Current Address
City
State
Zip Code
Dates lived here From
To
Please grade your credit	Select OneExcellentGoodOkaySome Late PaymentsLots of Lates/CollectionsDog-UglyOther (please specify in comments)

borrower's current employer

Company
Address
Employer Telephone Number
Job Title
Years in this profession	Select One1-3 Months3-6 Months6-12 Months1-1.5 Years1.5-2 Years2-3 Years3-5 Years5-10 Years10+ Years
Dates at this job From
To
Gross Income $
per	Select OneAnnual SalaryBi-weeklyWeeklyHourlyOther
Are you self employed?	Select OneYesNo	ÊÊ

borrower's previous employment

Company
Address
Employer Telephone Number
Job Title
Years in this profession	Select One1-3 Months3-6 Months6-12 Months1-1.5 Years1.5-2 Years2-3 Years3-5 Years5-10 Years10+ Years
Dates at this job From
To
Gross Income $
per	Select OneAnnual SalaryBi-weeklyWeeklyHourlyOther
Are you able to verify your income with tax returns, W2's, or paystubs (yes/no)?

co-borrower's current employer

Company
Address
Employer Telephone Number
Job Title
Years in this profession	Select One1-3 Months3-6 Months6-12 Months1-1.5 Years1.5-2 Years2-3 Years3-5 Years5-10 Years10+ Years
Dates at this job From
To
Gross Income $
per	Select OneAnnual SalaryBi-weeklyWeeklyHourlyOther
Are you able to verify your income with tax returns, W2's, or paystubs (yes/no)?

co-borrower's previous employment

Company
Address
Employer Telephone Number
Job Title
Years in this profession	Select One1-3 Months3-6 Months6-12 Months1-1.5 Years1.5-2 Years2-3 Years3-5 Years5-10 Years10+ Years
Dates at this job From
To
Gross Income $
per	Select OneAnnual SalaryBi-weeklyWeeklyHourlyOther
Are you able to verify your income with tax returns, W2's, or paystubs (yes/no)?

Automobile (Make, Model, Year)
Savings Account (Bank Name, Acct Number, Balance)
Checking Account (Bank Name, Acct Number, Balance)
Other Account (Bank Name, Acct Number, Balance)
Other Account (Bank Name, Acct Number, Balance)
Other Account (Bank Name, Acct Number, Balance)
Other Account (IRA, 401K, Keogh, etc.)
Do you have bank statement(s) showing the above balances?	Select OneYesNo

Have you found the property you would like to purchase?	Select OneYesNo
Which type of property is this?	Select OnePurchasing a Primary ResidenceSecond HomeInvestment Property

If you have found the property you would like to purchase, what is the address

Street address
City
State	Select One,RequiredALCOMTWY
Zip Code		(Required)
What is the maximum sales price that you would like to purchase?	Select OneEstimateActual
$
Down Payment Source	Select OneSavingsCheckingGift from relativeEquity from Sale of Previous homeRetirement Acct.StocksSale of Asset (such as a car)Other
What is the total amount of money you will have for down pymt. & closing costs? $

Property Address
Sold	Pending Sale	Rental being held for income
Type of property
Present Market Value
Amount of Mortgages and Liens
Gross Rental Income
Mortgage Payments
Insurance-Maintenance-Taxes-Misc
Net Rental Income

Any additional names under which credit has previously been received and indicate appropriate creditor name and account number.

Government Monitoring InformationThe federal government requires us to request gender and race information for certain types of loans related to a dwelling in order to monitor our compliance with equal credit opportunity, fair housing, and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a lender may not discriminate on the basis of this information, or on whether you choose to furnish it.

Borrower

Race/National Origin	Select OneI do not wish to furnish this informationAmerican Indian or Alaskan NativeCaucasian, not of Hispanic originBlack, not of Hispanic originHispanicOther (Please Specify)
Other
Gender	Select OneFemaleMale

Co-Borrower

Race/National Origin	Select OneI do not wish to furnish this informationAmerican Indian or Alaskan NativeCaucasian, not of Hispanic originBlack, not of Hispanic originHispanicOther (Please Specify)
Other
Gender	Select OneFemaleMale

Patriot Act Information (Required)

Gender	Select OneDriver's License NumberPassport NumberState Issued ID Number
Number
Expiration Date
State Issued

Co-borrower's Patriot Act Information (if applicable)

Gender	Select OneDriver's License NumberPassport NumberState Issued ID Number
Number
Expiration Date
State Issued

Additional Comments

BY CLICKING SUBMIT BELOW, YOU ATTEST THAT YOU (1) ARE THE APPLICANT NAMED IN THIS APPLICATION, AND (2) YOU REQUEST THAT FOR USA LOANS., EVALUATE YOUR CREDIT WORTHINESS USING COMMON METHODS INCLUDING, BUT NOT LIMITED TO, YOUR CREDIT RECORDS.

It is the policy of For USA Loans. that any personal information given in e-mails, verbally, or on applications will be used for the sole purpose of obtaining a mortgage loan offer/approval on your behalf. While it may be necessary to provide this information to credit bureaus, appraisers, title companies, or our investor(s) for the purpose of determining your credit worthiness, the information you provide will not otherwise be disclosed, sold, traded, or bartered to any business entity or individual without your consent.
Your information will be given only to parties who need the information to consider your loan application.