Loan Request Form

QUICK APPLICATION (SECURE)

Please take a moment to fill out this application as completely as possible.

We are currently accepting applications in Virginia only.

Applicants should complete this form as "Borrower" or "Co-Borrower" as applicable. Co-borrower information must also be provided (and the appropriate box checked) when

the income or assets of a person other than the "Borrower" (including the Borrower's spouse) will be used as a basis for loan qualification or

the income or assets of the Borrowers spouse will not be used as a basis for loan qualification, but his or her liabilities must be considered because the Borrower resides in a community property state, the security property is located in a community property state, or the Borrower is relying on other property located in a community property state as a basis for repayment of the loan.

I. TYPE OF MORTGAGE AND TERMS OF LOAN

Mortgage Applied for:	Property Type:	Loan Amount $	No. of Months
Interest Rate %	Amortization Type:	Purchase Price or Approximate Home Value $

II. PROPERTY INFORMATION AND PURPOSE OF LOAN

Subject Property Address:
Street: No. of Units:
City: State: Zip Code:
Purpose of Loan:	Property will be:	Estate will be held in:
If refinancing, purpose of Refinance

III. BORROWER INFORMATION

Borrower:

First Name:

Last Name:
(include Jr. or Sr. if applicable)

Social Sec. No.:

Home Phone: (incl. area code)

E-mail Address:

Present Address: Own/Rent No. Yrs.

Street:

City: State: Zip Code:

If at present address less than two years complete the following:

Former Address: Own/Rent No. Yrs.

Street:

City: State: Zip Code:

Co-Borrower: (required only if the income or assets of a person other than the Borrower (including the Borrower's spouse) will be used as a basis for loan qualification.)

First Name:

Last Name:
(include Jr. or Sr. if applicable)

Social Sec. No.:

Home Phone: (incl. area code)

E-mail Address:

Present Address: Own/Rent No. Yrs.

Street:

City: State: Zip Code:

If at present address less than two years complete the following:

Former Address: Own/Rent No. Yrs.

Street:

City: State: Zip Code:

IV. EMPLOYMENT INFORMATION

Borrower:

Self Employed
Employer Name
Employer Address
Employer City/State/Zip

Yrs. on this job:

Business Phone: (incl. area code)

If employed in current position for less than two years or if currently employed in more than one position, complete the following:

Self Employed

Employer Name
Employer Address
Employer City/State/Zip

Dates (from - to)
Please use the following format YYYYMMDD
-

Co-Borrower: (required only if the income or assets of a person other than the Borrower (including the Borrower's spouse) will be used as a basis for loan qualification.)

Self Employed
Employer Name
Employer Address
Employer City/State/Zip

Yrs. on this job:

Business Phone: (incl. area code)

If employed in current position for less than two years or if currently employed in more than one position, complete the following:

Self Employed

Employer Name
Employer Address
Employer City/State/Zip

Dates (from - to)
Please use the following format YYYYMMDD
-

V. MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION

Borrower

Co-Borrower

Gross Monthly Income Total

* Self Employed Borrower(s) may be required to provide additional documentation such as tax returns & financial statements.

Monthly Housing Expense Total

* all housing expenses excluding utilities.

Other Monthly Income (rental, alimony, stocks, bonds, etc.)

* Notice: Alimony, child support, or separate maintenance income need not be revealed if the borrower (b) or coborrower (c) does not choose to have it considered for repaying this loan.

VI. ASSETS AND LIABILITIES

This statement and any applicable supporting schedules may be completed jointly by both married and unmarried co-borrowers if their assets and liabilities are sufficiently joined so that the statement can be meaningfully and fairly presented on a combined basis; otherwise separate statements and schedules are required. If the co-borrower section was completed about a spouse, this statement and supporting schedules must be completed about the spouse also. Completed: Jointly Not Jointly
ASSETS List all available assets including savings and checking accounts, stocks and bonds, life insurance cash value, real estate owned, vested interest in retirement fund, net worth of business(es) owned, automobiles owned, other assets, etc.
Total Assets	$
LIABILITIES List all outstanding debts, including automobile loans, revolving charge accounts, real estate loans, alimony, child support, stock pledged, etc.
Total Liabilities	$
Total Liabilities Monthly Payment	$

VIII. DECLARATIONS

Items	Borrower	Co-Borrower
a. Are there any outstanding judgments against you?	Yes No	Yes No
b. Have you been declared bankrupt within the last 7 years?	Yes No	Yes No
c. Have you had property foreclosed upon in the last 7 years?	Yes No	Yes No
d. Are you a party to a lawsuit?	Yes No	Yes No
e. Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment?	Yes No	Yes No
f. Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond or loan guarantee?	Yes No	Yes No
g. Are you obligated to pay alimony, child support, or separate maintenance?	Yes No	Yes No
h. Is any part of the down payment borrowed?	Yes No	Yes No
i. Are you the co-maker or endorser on a note?	Yes No	Yes No
j. Are you a U.S. citizen?	Yes No	Yes No
k. Are you a permanent resident alien?	Yes No	Yes No
l. Do you intend to occupy the property as your primary residence? (if "Yes," complete question m below.)	Yes No	Yes No
m. Have you had an ownership interest in a property in the last 3 years?	Yes No	Yes No
1. What type of property did you own --- principal residence (PR), second home (SH), or investment property (IP)?	PR SH IP	PR SH 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)?	S SP O	S SP O

IX. ACKNOWLEDGMENT AND AGREEMENT

The undersigned specifically acknowledge(s) and agree(s) that:(1) The loan requested by this application will be secured by a first mortgage or deed of trust on the property. Described herein; (2) the property will not be used for any illegal or prohibited purpose or use; (3) all statements made in this application are made for the purpose of obtaining the loan indicated herein; (4) occupation of the property will be as indicated above; (5) verification or re-verification of any information contained in the application may be made at any time by the Lender, its agents, successors and assigns, either directly or through a credit reporting agent, from any source named in this application, and the original copy of this application will be retained by the Lender, even if the loan is not approved; (6) the Lender, its agents, successors and assigns will rely on the information contained in the application and I/we have a continuing obligation to amend and/or supplement the information provided in this application if any of the material facts which I/we have represented herein should change prior to closing; (7) in the event my/our payments on the loan indicated in this application become delinquent, the Lender, its agents, successors and assigns, may, in addition to all their other rights and remedies, report my/our name(s) and account information to a credit reporting agency; (8) ownership of the loan may be transferred to successor or assign of the lender without notice to me and/or the administration of the loan account may be transferred to an agent, successor or assign of the lender with prior notice to me; (9) the Lender, its agents, successors and assigns make no representations or warranties, expressed or implied, to the Borrower(s) regarding the property, the condition of the property, or the value of the property.
Certification; I/we certify that the information provided in this application is true and correct as of the date set forth opposite my/our signature(s) on this application and acknowledge my/our understanding that my intentional or negligent misrepresentation(s) of the information contained in this application may result in civil liability and/or criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of title 18, United States Code, Section 1001, et seq. and liability for monetary damages to the lender, its agents, successors and assigns, insurers and any other person who may suffer any loss due to the reliance upon any misrepresentation which I/we have made on this application.

Borrower	Date
Co-Borrower	Date

Please contact me as soon as possible regarding this matter.