"*" indicates required fields Uniform Residential Loan ApplicationBorrowerName:* First Social Security Number:* Phone:*Email Address:* DOB:* MM slash DD slash YYYY Yrs School:* Marital Status:* Number of Dependents*Ages*Current Address* Street Address Address Line 2 City State / Province / Region HiddenMailing Address If Different than Current Address*Is the Mailing Address Different Than the Current Address?* Yes No Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Name of Employer:* Self Employed?* Employer Address:* Street Address City State / Province / Region Position/Title* Employer Phone*Yrs at current Job* Yrs in this line of work* Gross Monthly IncomeIf employed in current position for less than two years or If currently employed in more than one position, complete the following:HiddenSelectYesNoHave you been employed in your current position for less than two years at your current job, or currently employed in more than one position? Yes No Name of the Employer:* Self Employed?* Employer Address* Street Address City State / Province / Region Position/Title* Employer Phone*Yrs at current Job* Yrs in the line of work* Gross Monthly IncomePlease answer the following questions.1. Are you a U.S citizen* Yes No 2. Are you a permanent resident alien ?* Yes No In the last 7 years you have had a bankruptcy, foreclosure, or been party to a Lawsuit? If yes, please explain.In the last 7 years you have had a bankruptcy, foreclosure, or been party to a Lawsuit? If yes, please explain. Yes No ExplanationBorrower*Borrower Signature* Date* MM slash DD slash YYYY Borrower:* I do not wish to furnish this info Ethnicity* Hispanic or Latino Not Hispanic or Latino Race* American Indian or Alaska Native Asian Black or African American Native Hawaiian or other Pacific Islander White Sex:* Male Female Is there a co-borrower?* Yes No Co-BorrowerName:* First Social Security Number:* Phone:*Email Address:* DOB:* MM slash DD slash YYYY Yrs School:* Marital Status:* Number of Dependents* Ages* Current Address* Street Address City State / Province / Region Mailing Address If Different than Current Address*Name of Employer:* Self Employed?* Employer Address:* Street Address City State / Province / Region Position/Title* Employer Phone* Yrs at current Job Yrs in this line of work If employed in current position for less than two years or If currently employed in more than one position, complete the following: Name of the Employer: Self Employed? Employer Address* Street Address City State / Province / Region Position/Title* Employer Phone*Yrs at current Job* Yrs in the line of work Please answer the following questions. 1. Are you a U.S citizen* Yes No 2. Are you a permanent resident alien ?* Yes No In the last 7 years you have had a bankruptcy, foreclosure, or been party to a Lawsuit? If yes, please explain. Co-Borrower*Co-Borrower Signature* Date MM slash DD slash YYYY Co-Borrower:* I do not wish to furnish this info Ethnicity* Hispanic or Latino Not Hispanic or Latino Race* American Indian or Alaska Native Asian Black or African American Native Hawaiian or other Pacific Islander White Sex:* Male Female EmailThis field is for validation purposes and should be left unchanged.
