Borrower		Co-Borrower
	Yes	No	Yes	No
a. Are there any outstanding judgements 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 obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgement? (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.)
f. Are you presently delinquint or in default on any Federal debt of any other loan, mortgage, financial obligation bond, or loan guarantee? If "Yes," give details as described in the preceding question.?
g. Are you obligated to pay alimony, child support, or separate maintenance?
h. Is any part of the down payment borrowed?
i. Are you co-maker 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? If "yes," complete question m below.
m. Have you had an ownership interest in a property in the last three years?
(1) What type of property did you own: principal 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)?

ACKNOWLEDGEMENT AND AGREEMENT

The undersigned specifically acknowledge(s) and agree(s) that: (1) the loan requested by this application will be secured by a first mortgage or deed or trust on the property described herein; (2) the property will not be used for any illegal or prohibited purpose or use; (3) all statements made in this application are made for the purpose of obtaining the loan indicated herein; (4) occupation of the property will be as indicated above; (5) verification or reverification of any information contained in the application may be made at any time by the Lender, its agents, successors and assigns, either directly or through a credit reporting agency, from any source named in this application, and the original copy of this application will be retained by the Lender, even if the loan is not approved; (6) the Lender, its agents successors and assigns will rely on the information contained in the application and I/we have a continuing obligation to amend and/or supplement the information provided in this application of any of the material facts which I/we have represented herein should change prior to closing; (7) in the event my/our payments on the loan indicated in this application become delinquent, the Lender, its agents, successors and assigns, may in addition to all their other rights and remedies, report my/our name(s) and account information to a credit reporting agency; (8) ownership of the loan may be transferred to successor or assign of the Lender with prior notice to me; (9) the Lender, its agents, successors and assigns make no representations or warranties, express or implied, to the Borrower(s) regarding the property, the condition of the property, or the value of the property. Certification: I/We certify that the information provided in this application is true and correct as of the date this application is submitted 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. Authorization: I / We hereby authorize the Lender / Broker to verify past and present employment earnings records, bank accounts, stock holdings, and any other asset balances that are needed to process my / our mortgage loan application. I / we further authorize the Lender / Broker to order a consumer credit report and verify other credit information, including past and present mortgage and landlord references. The information the Lender / Broker obtains is only to be used in the processing of my application for a mortgage loan. I / We have read and agree to the above information. Borrower   Co-Borrower   (Change names above in borrower / co-borrower section.)

INFORMATION FOR GOVERNMENT MONITORING PURPOSES
The following information is requested by the Federal Government for certain types of loans related to a dwelling, in order to monitor the Lender's compliance with equal credit opportunity, fair housing and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a Lender may neither discriminate onthe basis of this information, nor on whether you choose to furnish it. However, if you choose not to furnish it, under Federal regulations this Lender is required to note race and sex on the basis of visual observation or surname. If you do not wish to furnishthe above information, please check the box below. (Lender must review the above material to assure that the disclosure satisfy all requirements to which the Lender is subject under applicable state law for the particular type of loan applied for.)
BORROWER	CO-BORROWER
I do not wish to furnish this information Ethnicity:   Hispanic or Latino   Not Hispanic or Latino Race: American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Sex: Female   Male	I do not wish to furnish this information Ethnicity:   Hispanic or Latino   Not Hispanic or Latino Race: American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Sex: Female   Male

Submitting this application does not lock-in the Interest rate as posted. All applications must be confirmed verbally.