Secure Mortgage Application (651) 552-3681
Borrower Basic Information 

 * = Required Information

Filling out the online application should take only about 10 minutes. Completing the application does not obligate you to anything. Rather, it simply gives us all the information needed to make an initial determination on what programs you qualify for, how much house you can buy, how much money you may need, and what payments might look like. You must still agree and consent to actually move forward with a loan. This is secure form, which means your information will be encrypted before being transmitted to us. If you have any question while filling out this form, please contact us at (651) 552-3681 or click the LIVE Loan Officer link (if available)

Get the attention you deserve. Talk to real people after completing the application, NOT computers.

Your FULL Name (First, MI, Last) *
Is there a co-borrower? No   Yes
  If yes, co-borrower full name 
Email address *
Best Phone # *    Home or Cell
2nd best phone # 
  Home or Cell
* Work Phone #  (REQUIRED for verification of employment)
Current Address *  
  State  Zip  
How long have you lived here  years  months
Do you currently
Old Address
(if at current less than 2 years)
  State  Zip
  Did you 
  How long did you live there  years  months
Date of Birth (format mo/da/year)  Required
Social Security Number  Required
Marital Status
Years of Schooling
Any dependents?  No  Yes
   If yes, how many? . Ages 
Credit Score
Bankruptcy? Ever File Bankruptcy? 
   If Yes, How long discharged? Years
Foreclosure? Ever Have A Foreclosure? 
   If Yes, How long ago? Years

Military Information

Are you or co-borrower US Military?
Current Status
If discharged, type
Ever had a VA loan before If Yes, did you default on the loan
Have your Certificate of Eligibility

Borrower Employment

  State  Zip 
Position/Title with Company
Start Date  Mo /  Year
How long in this line of work? Years
Are you self employed?
Former Employer (if less than 2 years with current employer)
  State Zip
  You worked there from when to when mo /yr until mo / yr
  Old Income , per 
  Former Position/Title 

Contacting You

We usually attempt to contact you between 10:00 AM & 6:00 PM Monday - Friday. 
If we are unable to contact you during this time frame, it could delay your application.
Daytime Contact  at 

Basic Loan Information

Type of Loan (Fixed, ARM, FHA, etc) 
Amortization Term:  6 yr - 30 yr available
Estimate Loan Amount Needed $
Property will be our
I applying today for
Estimated Closing Time

Purchasing a home?

What is the Purchase Price?  (estimate if pre-approval)
Down Payment %
Amount of Down Payment $ .00
Source of Down Payment:
Property Taxes on New Home? $  (if known)
Are you working with a Realtor?   Yes, info below  No realtor yet  Please refer a great one
Realtors Info: Name  Ph#  

Subject Property Information:

The Home you are buying or refinancing
Same as mailing address?  Yes
Found property?  Yes (address below)   No (Still Looking)
  State  Zip  (we lend in MN, WI, and SD only)

Monthly Income:

Gross Monthly Income (Pre-Tax)
Base Income $  per 
Net Rental Income
Other  (Child Support, Social Security, Pension, etc)
Explain 'other' Income 

Current Housing Costs:

Rent $
First Mortgage Payment (P/I) $ 
  Hazard Insurance $ Property Taxes $
  PMI $ Homeowner Assn. Dues $
Second Mortgage Payment (P/I) $

Assets: (Include all Applicants)

(includes checking, savings, stocks, mutual funds, etc.) (Include all Applicants Assets)
Account 1 $ Name of Bank 
Account 2 $ Name of Bank 
Account 3 $ Name of Bank 
All additional accounts $
Stocks and Bonds $ Name of Bank 
401(k)/Retirement $
Net Worth of Businesses Owned $


Who do you owe? (Include all Applicants debts)
Current 1st Mortgage Co
 or Landlord Name
. Monthly payment 
Current 2nd Mortgage Co . Monthly payment 

Alimony/Child Support

All other debts of ALL applicants (car loans, credit cards, student loans, etc) List only minimum required monthly payments
  $ per month.
  Total unpaid balance(s) $

Own Other Properties:

Own any other property NO YES
If "Yes" - What is it worth? $ How much do you owe on it? $

What is the payment?

First other property address  
  City St  Zip
2nd home or rental? 2nd home  Rental
Second other property address  
  City St  Zip
2nd home or rental? 2nd home  Rental
Rent? How much is rent? $


A. Are there any outstanding judgments against you?
B. Have you been declared bankrupt within the past 7 years?
C. Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?
D. Are you a party to a lawsuit?
E. Have you directly or indirectly been obliged on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure or judgment?
F. Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee?
G. Are you obligated to pay alimony, child support, or separate maintenance?
H. Is any part of the down payment borrowed?
I. Are you a co-signor or endorser on a note?
J. Are you a U.S. citizen?
K. Are you a permanent resident alien?
l. Do you intend to occupy the property as your primary residence?
M. Have you had an ownership interest in a property in the last three years?
(1.) What type of property did you own Principle residence (PR), second home (SH), or investment property (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)?


Information for Government Lender Monitoring purposes
The purpose of collecting this information is to help ensure that all applicants are treated fairly, and that the housing needs of the communities and neighborhoods are being fulfilled. For residential mortgage lending, Federal law requires we ask applicants for their demographic information (ethnicity, sex, and race) in order to monitor our compliance with equal credit opportunity, fair housing, and home mortgage disclosure laws.  You are not required to provide this information, but are encouraged to do so. You may select one or more designations for ethnicity and or more designations for race. The law provides that we may not discriminate on the basis of this information, or on whether you choose to provide it. However if you choose not to provide the information, and you have made the application in person, Federal regulations require us to note your ethnicity, sex, and race on the basis of visual observation or surname. The law also provides that we may not discriminate on the basis of age or marital status information you provide in this application.  If you do not wish to provide some or all of this information, please check below.
 I do not wish to answer

Multiple Entries OK

Race White
  Black or African American
       Asian Indian Chinese Filipino  Japanese
     Korean Vietnamese Other Asisan.
     If 'other' enter Example: Hmong, Pakastani, and so on.
Native Hawaiian or other Pacific Islander
       Native Hawaiian Guamanian or Chamorro  Samoan
     Other Pacific Islander.
      If 'other' enter Example: Fijan, Tongan, and so on.
  American Indian or Alaska Native
        Name of enrolled or principal tribe
  I do not wish to answer
Ethnicity: NOT Hipanic or Latino
  Hispanic or Latino
        Mexican  Puerto Rican  Cuban  Other Hispanic or Latino
         If other, enter origin Example: Argentinean, Columbian, Spaniard, etc.
  I do not wish to answer  
Gender Male  Female  Do not wish to answer

Other Information:

Please write in any other information you feel is important to us making our decision, or answers to any YES questions in the declarations section.
How did you find out about us   
This help's keep our advertising dollar effective, therefore reducing YOUR closing costs!




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