the income or assets of a person other than the "Borrower" (including the Borrowers 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, or 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.  

Your email address:

Type of Mortgage and Terms of Loan

Amount of Loan Request: $ Purpose:

Amortization Type: Fixed Rate Graduated Payment Mortgage Adjustable Rate Mortgage Other

No. of Months:   Interest Rate:%   

Mortgage Applied For:
Conventional / FHA / VA / FmHA / Other(Explain) 

Property Information and Purpose of Loan

Property Address:Street:City:St:Zipcode:

Legal Description of Subject Property:

No. of Units:  Year Built:

Property will be:                     Owner Occupied?Yes / No  
Primary Residence / Secondary Residence / Investment

Title will be held in the name:

Estate will be held in:  Source of Downpayment:
Fee Simple  / Leasehold

Annual Real Estate taxes: $

Annual Hazard Insurance: $

Complete this section if this is a refinance loan

Year Acquired:      Original Cost:         Existing Liens:         Purpose of Refinance:
             

Describe Improvements:made / to be made

Costs:

BORROWER INFORMATION

Name: Social Security Number:

Home Phone: Age: Years School:

Marital Status: Married Unmarried Legally Separated

Dependents: Number: Ages:

Street Address: City

State: ZIP: Do You: Own Rent Other How long::

Previous Address (if less than 2 years):

EMPLOYMENT INFORMATION

Employer: City, State:

Years at this job: Years employed in this job type:

Self Employed: Business Phone:

Position: Monthly Gross Income:

Previous Employment (if less than 2 years):

Other Income: (Alimony, child support and maintenance need not be revealed if applicant's) does not choose to have it considered as a basis for repaying this obligation): Source:

CO-BORROWER INFORMATION

Name: Social Security Number:

Home Phone: Age: Years School:

Marital Status: Married Unmarried Legally Separated

Dependents: Number: Ages:

Street Address: City

State: ZIP: Do You: Own Rent Other How long::

Previous Address (if less than 2 years):

CO-BORROWER EMPLOYMENT INFORMATION

Employer: City, State:

Years at this job: Years employed in this job type:

Self Employed: Business Phone:

Position: Monthly Gross Income:

Previous Employment (if less than 2 years):

Other Income: (Alimony, child support and maintenance need not be revealed if applicant's) does not choose to have it considered as a basis for repaying this obligation): Source:

ASSETS

LIABILITIES

List all debt (i.e. auto loans, personal loans, credit cards, mortgages):

Additional information you may want to provide:

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 any 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 reliance upon any misrepresentation which I/we have made on this application.

By submitting this application  I/We hereby authorize Riverside Financial Services or their assigns, to obtain credit reports and credit information as necessary to promptly and fairly evaluate my/our request for credit.

If mailing or faxing sign here ______________________Date________

Co Borrower________________________________Date______