Loan Request
*Amount Requested $    
Type of Loan
Primary Borrower/Applicant Information
General Information
*First Name  
Middle Initial
*Last Name  
*Date of Birth (mm/dd/yyyy)    
*Social Security Number (xxx-xx-xxxx)    
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. You may select one or more designations for "Race." The law provides that a lender may not discriminate on the basis of this information, or on whether you choose to furnish it. However, if you choose not to furnish the information and you have made this application in person, under the federal regulations the lender is required to note ethnicity, race, and sex on the basis of visual observation or surname. If you do not wish to furnish the information, please check below.
Ethnicity
Race
Hold ctrl key to select multiple items
Sex
Marital Status
Contact Information
Please enter all addresses in which you have lived for the past two years.
*Current Address  
Apt. #
*City  
*State  
*Zip Code    
*  
If renting, please list landlord name
*Length of Residency Year(s) Month(s)    
*Home Phone    
Work Phone  
Fax Number
*Email Address    
*Contact Me  
*When?  
   
First Previous Address
Apt. #
City
State
Zip Code
 
If rented, please list landlord name
Length of Residency Year(s) Month(s)  
   
Second Previous Address
Apt. #
City
State
Zip Code
 
If rented, please list landlord name
Length of Residency Year(s)  Month(s)  
   
Third Previous Address
Apt. #
City
State
Zip Code
 
If rented, please list landlord name
Length of Residency Year(s)  Month(s)
Employment Information

Please list all jobs you have had during the past two years. If self-employed, fill in personal business information.

*Are you self-employed?  
*Current Employer's Name  
*Phone Number    
*Length of Employment Year(s) Month(s)    
First Previous Employer's Name  
Phone Number
Length of Employment Year(s)  Month(s)
Second Previous Employer's Name  
Phone Number
Length of Employment Year(s)   Month(s)   

Note: Alimony, child support or additional sources of income need not be revealed if you do not wish them to be considered as a basis of repayment for this obligation.

*Gross Monthly Income

$    

 
Loan Information
*What will be the source of your down payment?  
Is your home currently secured by a mortgage loan? If so, please complete the following mortgage balance(s).
List approximate value of present home $  
Mortgage Balance(s)
First: Held By:   Payment:  
Second:   Held by:   Payment:
Credit References
Creditor: Amount Owed: Is Balance paid monthly? Monthly Payment
$ $
$ $
$ $
$ $
$ $
$ $
*Have you spoken with a Loan Officer?  
If so, who?  
Please list any additional monthly debts and information.

By clicking "Submit Application", you authorize BankPlus to check your credit, business and employment history.

This also grants BankPlus permission to contact you regarding the details of your loan.

If a joint application is submitted, you acknowledge that you intend to apply for joint credit.