test - Upstate Mortgage

Borrower First Name*

Borrower Middle Initial(s)

Borrower Last Name*

Borrower Email*

Enter Email Confirm Email

Privacy Policy*

I accept the terms of the privacy policy

We take our clients' financial privacy very seriously. During the course of processing your application, we accumulate non-public personal financial information from you and from other sources about your income, your assets, and your credit history in order to allow a lender to make an informed decision about granting you credit. We restrict access to nonpublic personal information about you to those employees who need to know that information to provide products or services to you. We maintain physical, electronic, and procedural safeguards that comply with federal regulations to guard your nonpublic personal information. We collect nonpublic information about you from the following sources: (i) information we receive from you on applications or other forms; (ii) information about your transactions with us, our affiliates, or others; and (iii) information we receive from a consumer reporting agency. We do not disclose any nonpublic information about our customers or former customers to any third party, except as permitted by law.

Loan Information

Purpose of Loan*

Purchase Price $*

Estimated Property Value $*

Loan Amount Requested $*

The amount you want to borrow.

Do you have an executed contract?

Yes
No

Please select yes if you have submitted an offer to purchase the property in question.

Amount of Down Payment $

Estimated Amount of Money Down

Source of Down Payment

Subject Property Address

Street Address City State ZIP Code

Personal Information

Social Security #*

Date of Birth*

Marital Status

Home Phone or Cell Phone*

Number of Dependents

Current Address*

Street Address City State ZIP Code

Length at Current Address

Years*

Months*

Previous Address*

Street Address City State ZIP Code

Length at Previous Address

Years at Previous Address*

Months at Previous Address*

Employment and Income

Are You Currently Employed?*

Yes
No

Current Employer Name*

Position*

Self-employed?*

Yes
No

How Long with Current Employer?

At Current Job for 2 Years or More?*

Yes
No

Years at Current Job*

Months at Current Job*

Total Months at Current Job*

Total 1

How Long with Previous Employer?

Total Months at Previous Job 1*

Previous Employer 1:*

Previous Employer 1 Position:*

Total 1+2

Total Months at Previous Job 2*

Previous Employer 2:*

Previous Employer 2 Position:*

Total 1+2+3

Total Months at Previous Job 3*

Previous Employer 3:*

Previous Employer 3 Position:*

Monthly Base Income Before Taxes $*

Gross Monthly Income

Monthly Average Overtime $

Estimated overtime if applicable

Monthly Average Bonuses $

Estimated monthly bonuses if applicable

Monthly Average Commission $

Estimated monthly commission if applicable

Other Income

Alimony, child support, or separate maintenance income need not be revealed if the applicant does not choose to have it considered for repaying the loan.

Other Income Source

Monthly Income $

Asset Details

Please provide information about your asset accounts. These may include Checking, Savings, Money Markets, Retirement Accounts, etc.

Account / Asset Type

Cash Value $

Enter Another Account?

Yes
No

Account / Asset Type

Cash Value $

Enter Another Account?

Yes
No

Account / Asset Type

Cash Value $

Monthly Housing Expenses

Please provide total housing expenses. Include expenses for the current residence only.

Do you rent or own your home?*

Rent $*

Mortgage Payment $*

monthly mortgage payment

Does the payment include taxes and insurance?

Yes
No

Declarations

Are there any outstanding judgements against you?*

Yes
No

Have you been declared bankruptcy within the past 7 years?*

Yes
No

Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?*

Yes
No

Are you a party to a lawsuit?*

Yes
No

Have you been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgement?*

Yes
No

Are you presently delinquent or in default on any Federal debt or any other loans?*

Yes
No

Are you obligated to pay alimony, child support, or separate maintenance?*

Yes
No

Amount Paid Monthly

Is any part of the down payment borrowed?*

Yes
No

Are you a co-maker or endorser on a note?*

Yes
No

Are you a U.S. citizen?*

Yes
No

Are you a permanent resident alien?*

Yes
No

Do you intend to occupy the property as your primary residence?*

Yes
No

Have you had an ownership interest in a property in the last three years?*

Yes
No

What type of property did you own?

Principal Residence
Second Home
Investment Property

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*

American Indian or Alaska Native
Black or African American
Native Hawaiian or Other Pacific Islander
Asian
White

Co-Borrower Information

Do you have a co-borrower?*

Yes
No

A co-borrower is someone who, along with you, accepts responsibility for repaying the loan.

Co-Borrower First Name*

Co-Borrower Middle Initial(s)

Co-Borrower Last Name*

Co-Borrower Date of Birth*

Co-Borrower Social Security #*

Current address same as borrower?*

Yes
No

Current Address*

Street Address City State ZIP Code

Length at Current Address

Years*

Months*

Length at Previous Address

Previous Address*

Street Address City State ZIP Code

Years at Previous Address*

Months at Previous Address*

Employment and Income

Are You Currently Employed?*

Yes
No

Employment Information

Please enter employment information for the past 2 years.

Current Employer Name (Co-Borrower)*

Position (Co-Borrower)

Self-employed? (Co-Borrower)*

Yes
No

How Long with Current Employer?

At Current Job for 2 Years or More? (Co-Borrower)*

Yes
No

Years at Current Job*

Months at Current Job*

Total Months at Current Job*

Total 1 (Co Borrower)

How Long with Previous Employer?

Total Months at Previous Job 1*

Previous Employer 1:*

Previous Employer 1 Position:*

Total 1+2 (Co Borrower)

Total Months at Previous Job 2*

Previous Employer 2:*

Previous Employer 2 Position:*

Total 1+2+3 (Co Borrower)

Total Months at Previous Job 3*

Previous Employer 3 Position:*

Previous Employer 3:*

Monthly Base Income $ (Co-Borrower)*

Monthly Overtime $ (Co-Borrower)

Monthly Bonuses $ (Co-Borrower)

Monthly Commission $ (Co-Borrower)

Co-Borrower Asset Details

Please provide information about your asset accounts. These may include Checking, Savings, Money Markets, Retirement Accounts, etc.

Co-Borrower Account / Asset Type

Cash Value $

Enter Another Account?

Yes
No

Co-Borrower Account / Asset Type

Cash Value $

Enter A Third Account?

Yes
No

Co-Borrower Account / Asset Type

Cash Value $

Co-Borrower Declarations

Are there any outstanding judgements against you?*

Yes
No

Have you been declared bankrupt within the past 7 years?*

Yes
No

Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?*

Yes
No

Are you a party to a lawsuit?*

Yes
No

Have you been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgement?*

Yes
No

Are you presently delinquent or in default on any Federal debt or any other loans?*

Yes
No

Are you obligated to pay alimony, child support, or separate maintenance?*

Yes
No

Amount Paid Monthly

Is any part of the down payment borrowed?*

Yes
No

Are you a co-maker or endorser on a note?*

Yes
No

Are you a U.S. citizen?*

Yes
No

Are you a permanent resident alien?*

Yes
No

Do you intend to occupy the property as your primary residence?*

Yes
No

Have you had an ownership interest in a property in the last three years?*

Yes
No

What type of property did you own?

Principal Residence
Second Home
Investment Property

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*

American Indian or Alaska Native
Black or African American
Native Hawaiian or Other Pacific Islander
Asian
White