Short Information Form

First Name*

Middle Initial

Last Name*

Email*

Enter Email Confirm Email

Home/Cell Phone

Current Address*

Street Address City State ZIP Code

How did you hear about us?*

Referral Name

Subject Property Information

Purpose of Loan*

Loan Amount $*

This is the amount you want to borrow.

Purchase Price $*

Estimated Property Value $*

Subject Property Address (if known)

Street Address City State ZIP Code

Monthly Income Before Taxes

Total Monthly Gross Income $

Assets

Checking

Savings

Retirement Funds

Other

Information for Government Monitoring

The following information is requested by the federal government for certain types of loans related to a dwelling in order to monitor the lender's 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. You may select one or more designations for "Race." The law provides that a lender may not discriminate on the basis of this information, or on whether you choose to furnish it. However, if you choose not to furnish the information and you have made this application in person, under federal regulations the lender is required to note ethnicity, race, and sex on the basis of visual observation or surname. If you do not wish to furnish the information, please check below.

Option

I do not wish to furnish this information

Sex*

Male
Female

Ethnicity*

Hispanic or Latino
Not Hispanic or Latino

Race*

Co-Borrower Information

Do you have a co-borrower?

Yes
No

Co-borrower First Name*

Co-borrower Middle Initial

Co-borrower Last Name*

Co-borrower Home/Cell Phone

Co-borrower Current Address

Street Address City State ZIP Code

Co-Borrower Monthly Income

Total Monthly Gross Income $*

Co-Borrower Assets

Checking

Savings

Retirement Funds

Other

Information for Government Monitoring

The following information is requested by the federal government for certain types of loans related to a dwelling in order to monitor the lender's 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. You may select one or more designations for "Race." The law provides that a lender may not discriminate on the basis of this information, or on whether you choose to furnish it. However, if you choose not to furnish the information and you have made this application in person, under federal regulations the lender is required to note ethnicity, race, and sex on the basis of visual observation or surname. If you do not wish to furnish the information, please check below.

Co-Borrower: Option

I do not wish to furnish this information

Co-Borrower: Sex*

Male
Female

Co-Borrower: Ethnicity*

Hispanic or Latino
Not Hispanic or Latino

Co-Borrower: Race*

Name

This field is for validation purposes and should be left unchanged.

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with our Short Information Form

Subject Property Information

Monthly Income Before Taxes

Assets

Information for Government Monitoring

Co-Borrower Information

Co-Borrower Monthly Income

Co-Borrower Assets

Information for Government Monitoring