Name of Title Holder:*

How is this property held?* Please SelectIndividual Joint Joint-Survivorship

If leasehold, what is the expiration date?

Property Street Address: *

Property City: *

Property State: * Please SelectWisconsin AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Property ZIP Code: *

Legal description of property * (Tax Township / Lot / Block)

Year Built: *

Purpose of Loan:

Purpose of Refinance:

Year Acquired:

Original Cost:

Remaining Loan Amount:

Describe the improvements

Total Cost of Improvements:

First Name: *

Middle Initial:

Last Name: *

Suffix: Please SelectI II III IV Jr Sr

Social Security Number: * (###-##-####)

Birth Date: * (mm/dd/yyyy)

Email:

Mobile or Home Phone Number: *

Type of phone number: * Please SelectMobile Home

Phone Number Alternate:

Type of phone number: Please SelectMobile Home Office Fax

Phone Number Other:

Type of phone number: Please SelectMobile Home Office Fax

Street Address: *

City: *

State: * Please SelectWisconsin AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

ZIP Code: *

Mailing Address or PO BOX:

Mailing City:

Mailing State: Please SelectWisconsin AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Mailing ZIP Code:

Do you own or rent your housing? *

Own Rent Other

If other, please explain:

Residency Start Date: *

Monthly Mortgage or Rent Payment: *

Previous Street Address:

Previous City:

Previous State: Please SelectWisconsin AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

ZIP Code:

Number of Dependents (Not Listed by Co-Borrower) *

List Dependent's Ages:

Employment Start Date:

Position or Title:

Name of Employer:

Employer Address:

Employer City:

Employer State: Please SelectWisconsin AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Employer Zip Code:

Other Income Description 1:

Other Income Amount 1:

Other Income Description 2:

Other Income Amount 2:

Other Income Description 3:

Other Income Amount 3:

Other Income Description 4:

Other Income Amount 4:

Please total and enter the other monthly income amounts here:

Combined Monthly Rent:

Present First Mortgage (P&I)

Proposed First Mortgage (P&I)

Present Other Financing (P&I)

Proposed Other Financing (P&I)

Present Hazard Insurance

Proposed Hazard Insurance

Present Real Estate Taxes

Proposed Real Estate Taxes

Present Mortgage Insurance

Proposed Mortgage Insurance

Present Homeowner Association Dues

Proposed Homeowner Association Dues

Present Other

Proposed Other

Total Present:

Total Proposed:

Holder's Name:

Amount:

Insurer's Name:

Amount:

Account Number:

Institution Name:

Value:

Account Number:

Institution Name:

Value:

Account Number:

Institution Name:

Value:

Description:

Company Name:

Value:

Description:

Company Name:

Value:

Description:

Company Name:

Value:

Real estate owned (enter market value)
Total Value:

Vested interest in retirement fund
Total Value:

Net Worth of business(es) owned
Total Value:

Make:

Model:

Year:

Cash or Market Value:

Make:

Model:

Year:

Cash or Market Value:

Make:

Model:

Year:

Cash or Market Value:

Asset Description:

Cash or Market Value:

Asset Description:

Cash or Market Value:

Asset Description:

Cash or Market Value:

Unpaid Balance:

Monthly Payment:

Name of Liability Owner:

Account Number:

Liability Owner Address:

Liability Owner City:

Liability Owner State: Please SelectWisconsin AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Liability Owner ZIP Code:

Unpaid Balance:

Monthly Payment:

Name of Liability Owner:

Account Number:

Liability Owner Address:

Liability Owner City:

Liability Owner State: Please SelectWisconsin AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Liability Owner ZIP Code:

Unpaid Balance:

Monthly Payment:

Name of Liability Owner:

Account Number:

Liability Owner Address:

Liability Owner City:

Liability Owner State: Please SelectWisconsin AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Liability Owner ZIP Code:

Name of Party Paid to:

Monthly Support Payment:

Address:

City:

State: Please SelectWisconsin AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

ZIP:

Type of Property:

Present Market Value:

Total Mortgages and Liens:

Monthly Gross Rental Income:

Monthly Net Rental Income:

Monthly Mortgage Payments:

Monthly Insurance, Maintenance, Taxes & Misc.:

Address:

City:

State: Please SelectWisconsin AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

ZIP:

Type of Property:

Present Market Value:

Total Mortgages and Liens:

Monthly Gross Rental Income:

Monthly Net Rental Income:

Monthly Mortgage Payments:

Monthly Insurance, Maintenance, Taxes & Misc.:

Address:

City:

State: Please SelectWisconsin AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

ZIP:

Type of Property:

Present Market Value:

Total Mortgages and Liens:

Monthly Gross Rental Income:

Monthly Net Rental Income:

Monthly Mortgage Payments:

Monthly Insurance, Maintenance, Taxes & Misc.:

Total Real Estate Market Value:

Total Mortgages & Liens:

Total Gross Rental Income:

Total Net Rental Income:

Total Insurance, Maintenance, Taxes & Misc.:

Additional Name 1:

Additional Creditor 1:

Additional Account Number 1:

Additional Name 2:

Additional Creditor 2:

Additional Account Number 2:

Additional Name 3:

Additional Creditor 3:

Additional Account Number 3:

Are there any outstanding judgments against you? *
Yes No

If yes, please explain:

Have you been declared bankrupt within the past 7 years? *
Yes No

If yes, please explain:

Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years? *
Yes No

If yes, please explain:

Are you a party to a lawsuit? *
Yes No

If yes, please explain:

Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer or title in lieu of foreclosure, or judgment? (This would include such loans as home mortgage loans, SBA loans, home improvement loans, educational loans, manufactured (mobile) home loans, any mortgage, financial obligation, bond, or loan guarantee. If "Yes" provide details, including date, name and address of Lender, FHA or VA case number, if any, and reasons for the action.) *
Yes No

If yes, please explain:

Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee? If "Yes", give details as described in the preceding question. *
Yes No

If yes, please explain:

Are you obligated to pay alimony, child support, or separate maintenance? *
Yes No

If yes, please explain:

Is any part of the down payment borrowed? *
Yes No

If yes, please explain:

Are you a co-maker or endorser on a note? *
Yes No

If yes, please explain:

Are you a permanent resident alien? *
Yes No

If yes, please explain:

Have you had an ownership interest in a property in the last three years? *
Yes No

If yes above, please indicate property type and how the property was held:

Property Type: Please SelectPrincipal Residence Second Home Investment Property

How Held: Please SelectSoly Joint with Spouse Joint with Another Person

Are there any outstanding judgments against you?
Yes No

If yes, please explain:

Have you been declared bankrupt within the past 7 years?
Yes No

If yes, please explain:

Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?
Yes No

If yes, please explain:

Are you a party to a lawsuit?
Yes No

If yes, please explain:

Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer or title in lieu of foreclosure, or judgment? (This would include such loans as home mortgage loans, SBA loans, home improvement loans, educational loans, manufactured (mobile) home loans, any mortgage, financial obligation, bond, or loan guarantee. If "Yes" provide details, including date, name and address of Lender, FHA or VA case number, if any, and reasons for the action.)
Yes No

If yes, please explain:

Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee? If "Yes", give details as described in the preceding question.
Yes No

If yes, please explain:

Are you obligated to pay alimony, child support, or separate maintenance?
Yes No

If yes, please explain:

Is any part of the down payment borrowed?
Yes No

If yes, please explain:

Are you a co-maker or endorser on a note?
Yes No

If yes, please explain:

Are you a permanent resident alien?
Yes No

If yes, please explain:

If yes above, please indicate property type and how the property was held:

Property Type: Please SelectPrincipal Residence Second Home Investment Property

How Held: Please SelectSoly Joint with Spouse Joint with Another Person

Borrower Signature: *

Date: *

Co-Borrower Signature:

Date: