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Uniform Residential Loan Application 1003
This application is designed to be completed by the applicant(s) with the lender's assistance. 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 Borrower's 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 V.A. Conventional Other:
Applied for: FHA FmHA		 Agency Case #
 		 Lender Case #
 
Amount
$		 Interest Rate
          %		 No. of Months
 		 Amortization Fixed Rate Other (explain):
Type: GPM ARM(type):
II. PROPERTY INFORMATION AND PURPOSE OF LOAN
Subject Property Address (street , city, state,ZIP)
 No. of Units
 
Legal Description of Subject Property (attach description if necessary)

 Year Built
Purpose of Loan Purchase Construction Other (explain):
Refinance Construction-Permanent		 Property will be:
Primary Residence Secondary Residence Investment
Complete this line if construction or construction-permanent loan.
Year Lot
Acquired		 Original Cost
$		 Amount Existing Liens
$		 (a) Present Value of Lot
$		 (b) Cost of Improvements
$		 Total (a+b)
$
Complete this line if this is a refinance loan.
Year
Acquired		 Original Cost
$		 Amount Existing Liens
$		 Purpose of Refinance
 		 Describe Improvements made to be made
Cost $
Borrower                   III. BORROWER INFORMATION          ;   Co-Borrower
Borrower's Name (include Jr. or Sr. if applicable)
 		 Co-Borrower's Name (include Jr. or Sr. if applicable
 
Social Security #
 		 Home Phone (incl. area code)
 		 Age
 		 Yrs. School
 		 Social Security #
 		 Home Phone (incl. area code)
 		 Age
 		 Yrs. School
 
Married
Unmarried (include single divorced, widowed)
Separated		 Dependents
(not listed by Co- Borrower)
no#__________
ages__________		 Married
Unmarried (include single divorced, widowed)
Separated		 Dependents
(not listed by Borrower)
no#__________
ages__________
If residing at present address for less than two years, complete the following:
Previous Address (street, city, state, ZIP) Own Rent ____No. Yrs.

 
 Previous Address (street, city, state, ZIP) Own Rent ____No. Yrs.

 
Previous Address (street, city, state, ZIP) Own Rent ____No. Yrs.

 
 Previous Address (street, city, state, ZIP) Own Rent ____No. Yrs..

 
Borrower              IV. EMPLOYMENT INFORMATION              Co-Borrower
Name and Address of Employer Self Employed (check above box) Yrs. on this job
 Name and Address of Employer Self Employed (check above box) Yrs. on this job
Yrs. employed
in this line of
work/profession		 Yrs. employed
in this line of
work/profession
Position/Title/Type of Business Business Phone (incl. area code) Position/Title/Type of Business 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:
Name and Address of Employer Self Employed (check above box)
 Dates(from-to)
 Name and Address of Employer Self Employed (check above box)
 Dates(from-to)
Monthly Income
$		 Monthly Income
$
Position/Title/Type of Business

 

 Business Phone (incl. area code)

 

 Position/Title/Type of Business

 

 Business Phone (incl. area code)

 
Name and Address of Employer Self Employed (check above box)
 Dates(from-to)
 Name and Address of Employer Self Employed (check above box)
 Dates(from-to)
Monthly Income
$		 Monthly Income
$
Position/Title/Type of Business Business Phone (incl. area code) Position/Title/Type of Business Business Phone (incl. area code)

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Provided by RAND MILLER, Atlantic Security Fin. www.aLoanNow.com  (800) 644-LEND fax to 661 286 1468fx 661 244-4428fx