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1. Let's Get Acquainted
First Name* Last Name*
Telephone (Home)* Telephone (Business)*
Email* Fax
Loan Consultant:                         Credit Score:
2. Type of Mortgage and Terms of Loan
Mortgage Applied for:
Loan Amount:
Interest Rate: %
No. of Months:
Amortization Type:
3. Property Information and Purpose of Loan
State:
Zip Code: 
Purpose of Loan:
Property Will Be:
Purchase Price or Estimated Value:
Source of Down Payment, Settlement Charges, and/or Subordinate Financing:
4a. Borrower InformationSame as Applicant
First Name: *
Last Name: *
Social Security Number:
Evening Phone: *
Marital Status:
Number of Dependents:
(Count shared dependents once)
Date of Birth:(MM/DD/YYYY) *
 
Email Address: *
Present Address
Street:
City:
State:
ZIP Code:
Rent or Own?
How Long at Address:  years    months
Complete the following if at present address less than two years:
Former Address
Street:
City:
State:
ZIP Code:
Rent or Own?
How Long at Address:  years   months
4b. Co-borrower Information
First Name:
Last Name:
Social Security Number:
Evening Phone:
Marital Status:
Number of Dependents:
(Count shared dependents once)
Date of Birth:(MM/DD/YYYY)
Present Address ( Same as Borrower )
Street:
City:
State:
ZIP Code:
Rent or Own?
How Long at Address:  years   months
Complete the following if at present address less than two years.
Former Address ( Same as Borrower )
Street:
City:
State:
ZIP Code:
Rent or Own?
How Long at Address:  years  months
5. Employment Information
Current Employer
BorrowerCo-borrower
Employer Name:
Employer Address:
City, State & Zip
,
Self-employed: 
Time on Job:
   years  
Employer Name:
Employer Address:
City, State & Zip
,
Self-employed: 
Time on Job:
   years  
6. Monthly Income and Combined Housing Expense Information
GROSS MONTHLY INCOMEBORROWERCO-BORROWER
Base Empl. Income:
Overtime
Bonus
Commissions
Dividends/Interest:

Describe Other Income: Notice: Alimony, child support, or separate maintenance need not be revealed if you do not choose to have it considered for repayment of this loan.
 OwnerDescriptionMonthly Amount
#1BORROWER
#2BORROWER
#3BORROWER
#4CO-BORROWER
#5CO-BORROWER
#6CO-BORROWER
   
Combined Monthly Housing ExpenseWhere You Live NowProposed Loan
Rent:  
First Mortgage (P&I):
Other Financing (P&I):  
Hazard Insurance:
Real Estate Taxes:
Mortgage Insurance:
Homeowner Assn. Dues:
 

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1009 Staghorn Lane, Stroudsburg, PA 18360
1-570-402-1086 Fax: 1-570-992-8853 8 am to 6 pm EST

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