1003 Application

First Lenders Mortgage Loan Application

I. TYPE OF MORTGAGE AND TERMS OF LOAN

Amount		Interest Rate	Number of Months	Amortization Type:	Other (Explain):
$		%		Fixed Rate	ARM (Type):

II. PROPERTY INFORMATION AND PURPOSE OF LOAN

Subject Property Address:				City:	State:	Zip Code:	No. of Units

Legal Description of Property							Year Built

Purpose of Loan	Purchase	Refinance	Other (Explain):		Property will be: (check all that apply)
	FHA	Cash Out			Primary Residence Secondary Residence		Condo/Townhouse Investment
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:	$
Title will be held in what name(s)				Manner in which title will be held

Source of Down Payment, Settlement Charges and/or Subordinate Financing (explain):

III. Borrower Information

Borrower’s First Name (include Jr. or Sr. if applicable)*		Borrower’s Last Name (include Jr. or Sr. if applicable)*

Social Security Number		Date of Birth	Yrs. School

Home Phone*		Cell Phone

Married	Unmarried	Dependents (not listed by coborrower)
Seperated		No	Ages
Present Address (street, city, state, ZIP)	Own	Rent	No. Yrs.


Mailing Address (if different from above)


If residing at present address for less than two years, complete the following:
Former Address (street, city, state, ZIP)	Own	Rent	No. Yrs.

Co-Borrower’s First Name (include Jr. or Sr. if applicable)		Co-Borrower’s Last Name (include Jr. or Sr. if applicable)

Social Security Number		Date of Birth	Yrs. School

Home Phone		Cell Phone

Married	Unmarried	Dependents (not listed by borrower)
Seperated		No	Ages
Present Address (street, city, state, ZIP)	Own	Rent	No. Yrs.


Mailing Address (if different from above)


If residing at present address for less than two years, complete the following:
Former Address (street, city, state, ZIP)	Own	Rent	No. Yrs.

IV. Employer Information

Name & Address of Employer	Self Employed	Yrs. on this job

		Yrs. employed in this work/profession

Position/Title/Type of Business	Business Phone (inlcude 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 & Address of Employer	Self Employed	Dates (from-to)

		Monthly Income
		$
Position/Title/Type of Business	Business Phone (inlcude area code)

Name & Address of Employer	Self Employed	Dates (from-to)

		Monthly Income
		$
Position/Title/Type of Business	Business Phone (inlcude area code)

Name & Address of Employer	Self Employed	Yrs. on this job

		Yrs. employed in work/profession

Position/Title/Type of Business	Business Phone (inlcude 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 & Address of Employer	Self Employed	Dates (from-to)

		Monthly Income
		$
Position/Title/Type of Business	Business Phone (inlcude area code)

Name & Address of Employer	Self Employed	Dates (from-to)

		Monthly Income
		$
Position/Title/Type of Business	Business Phone (inlcude area code)

V. MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION
Gross Monthly Income	Borrower	Co-Borrower	Total	Combined Monthly Housing Expenses	Present	Proposed
Base Empl. Income*				Rent		NA
Overtime				First Mortgage (P&I)
Bonuses				Other Financing (P&I)
Commissions				Hazard Insurance
				Real Estate Taxes
				Mortgage Insurance
				Homeowner Assn. Dues
* Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.
Describe Other Income Notice: Alimony, child support, or separate maintenance income need not be revealed if the Borrower (B) or Co-Borrower (C) does not choose to have it considered for repaying this loan.
B/C					Monthly Amount

VI. ASSETS AND LIABILITIES

Schedule of Real Estate Owned (If additional properties are owned, use continuation sheet.)
Property Address (*enter S if sold, P if pending sale or R if rental being held for income)	*	Type of Property	Present Market Value	Amount of Mortgages & Liens	Gross Rental Income	Mortgage Payments	Insurance, Maintenance, Taxes & Misc.	Net Rental Income

VII. DECLARATIONS

If your answer is "Yes" to any questions a through i, please use continuation sheet for explanation.	Borrower		Co-Borrower
	Yes	No	Yes	No
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. Are you obligated to pay alimony, child support, or separate maintenance?
f. Is any part of the down payment borrowed?
g. Are you a co-maker or endorser on a note?

h. Are you a U.S. citizen?
i. Are you a permanent resident alien?
j. Do you intend to occupy the property as your primary residence?
k. 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)?
l. Are you presently doing any renovations/remodeling to the home that would affect the appraisal?
m. Do you own any other properties/land? ( even if there is no mortgage on the property)*
n. Do you have any second mortgage or Home equity loan on the property?*
o. Are you looking to escrow for taxes and insurance?*

VIII. INFORMATION FOR GOVERNMENT MONITORING PURPOSES

BORROWER	I do not wish to furnish this information.			CO-BORROWER	I do not wish to furnish this information.
Ethnicity:	Hispanic or Latino	Not Hispanic or Latino		Ethnicity:	Hispanic or Latino	Not Hispanic or Latino
Race:	American Indian or Alaska Native	Asian	Black or African American	Race:	American Indian or Alaska Native	Asian	Black or African American
	Native Hawaiian or Other Pacific Islander	White			Native Hawaiian or Other Pacific Islander	White
Sex:	Female	Male		Sex:	Female	Male

IX. OTHER INFORMATION

Explanations or Notes:

Borrowers' Email Address:*		Name and Address of Interviewer's Employer First Lenders Mortgage 6 Leonardville Road Middletown, New Jersey, 07748 NMLS# 274724 Phone: 732-275-1600 Fax: 732-957-9666 info@firstlendersmortgage.com
Co-Borrowers' Email Address:
How did you hear about us?:*
What is the value of the home being mortgaged?:*
* Required fields (if not filled out - you will have to fill out the form again.)