Purchase: Refinance: Loan Amount: Borrower's Last Name: Borrower's Middle Initial: Borrower's First Name: Borrower's Date of Birth: Co-Borrower's Last Name: Co-Borrower's Middle Initial: Co-Borrower's First Name: Co-Borrower's Date of Birth: Current Street Address: Current City/Town: Current State: Current Zip Code: Subject Property Street Address, City/Town, State and Zip Code: Property Type:
Please choose from list Primary Second Home Investment
Home Phone: Work Phone: Fax: E-Mail: Borrower's Social Security #: Co-Borrower's SS #: Liquid Assets: Institution
Balance
1) 2) Own or Rent: 1st Mortgage Balance: 2nd Mortgage Balance: Credit History: Self-Employed?: Employer: How long: Income: Income Type: Co-Borrower's Employer: How long: Co-Borrower's Income: Co-Borrower's Income Type:
Own Other Property?:
If you do not have
a loan officer, please tell us how you found us (a friend, Google, Yahoo, a
link from another site, etc.) 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 discriminate neither on the basis of this information, nor on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, this lender is required to note this information on the basis of visual observation or surname. If you do not wish to furnish the information, please check the box below. (Lender must review the above material to assure that the disclosures satisfy all requirements to which the lender is subject under application state law for the particular type of loan applied for.)
Hispanic or Latino Hispanic or Latino Not Hispanic or Latino American Indian or Alaska Native Asian
American Indian or Alaska Native Native Hawaiian or Other Pacific Islander Asian White African American or Black Female Male Female Male Any Additional Information: By clicking on the submit button, you agree to a credit check by SCR. This is in order to serve you better.
This page is secure for your protection and privacy (using 128-bit encryption). 
