21St Mortgage Credit Application – Fill Out and Use

21st Mortgage License No.

Date

Loan Originator:

Chris Corwin

License No.

Loan Assistant:

(A)

APPLICANT INFORMATION

(B)

CO-APPLICANT INFORMATION

FULL NAME-Last, First, Middle

No. dependents: _______

FULL NAME-Last, First, Middle

No. dependents: _______

List ages:

List ages:

BIRTHDATE

SOCIAL SECURITY #

BIRTHDATE

SOCIAL SECURITY #

MARITAL STATUS

!Married !Separated !Unmarried (Single, Divorced, Widowed

MARITAL STATUS

!Married !Separated !Unmarried (Single, Divorced, Widowed

PRESENT STREET ADDRESS (5 Year Residence Required

PRESENT STREET ADDRESS (5 Year Residence Required

CITY, STATE, ZIP CODE

COUNTY

CITY, STATE, ZIP CODE

COUNTY

HOW LONG AT

HOME PHONE#

HOW LONG AT

HOME PHONE#

______

______

______

______

PRESENT ADDRESS?

Years

Months

PRESENT ADDRESS?

Years

Months

EMAIL ADDRESS:

EMAIL ADDRESS:

RESIDENTIAL STATUS?

! Homeowner ! Renter

! Parents

! Other

RESIDENTIAL STATUS?

! Homeowner

! Renter

! Parents

! Other

PREVIOUS ADDRESS (If less than 5 yrs at present)

How long?

PREVIOUS ADDRESS (If less than 5 yrs at present)

How long?

______

______

______

______

Years

Months

Years

Months

Applicant’s Employment (Minimum 3 year History)

Co-Applicant’s Employment (Minimum 3 year History)

EMPLOYER

PHONE

EMPLOYER

PHONE

EMPLOYER’S ADDRESS

TYPE OF BUSINESS

EMPLOYER’S ADDRESS

TYPE OF BUSINESS

POSITION

SUPERVISOR

DATE EMPLOYED

POSITION

SUPERVISOR

DATE EMPLOYED

GROSS SALARY/MTH

GROSS OTHER INCOME

SOURCE

GROSS SALARY/MTH

GROSS OTHER INCOME

SOURCE

$

$

$

$

PREVIOUS EMPLOYER

PHONE

PREVIOUS EMPLOYER

PHONE

CITY, STATE

POSITION

EMPLOYED

CITY, STATE

POSITION

EMPLOYED

FROM

TO

FROM

TO

CREDIT REFERENCES AND PAYMENT OBLIGATIONS

COMBINED PAYMENTS FOR ALIMONY $

CHILD SUPPORT $

CHILD CARE $

HAVE EITHER OF YOU HAD A BANKRUPTCY, REPOSSESSION, OR JUDGEMENT IN THE LAST 10 YEARS?

YES

NO

CHECKING ACCOUNT WITH

SAVINGS? TYPE

SAVINGS ACCOUNT

401K RETIREMENT PENSION

WITH

LAST VEHICLE, TRUCK, OR MOBILE HOME FINANCED BY

YEAR MAKE MODEL

MTHLY PMT

PRESENT BAL

APPLICANT’S RELATIVE

CO-APPLICANT’S RELATIVE

NEAREST RELATIVE NOT LIVING WITH YOU

HOME PHONE #

NEAREST RELATIVE NOT LIVING WITH YOU

HOME PHONE #

RELATIONSHIP

ADDRESS

BUSINESS PHONE

RELATIONSHIP

ADDRESS

BUSINESS PHONE

WILL THIS BE PRIMARY RESIDENCE ___ YES

___ NO (if no explain) ____________________________________________________________________________

IN ADDITION TO YOUR MOBILE HOME, WHAT ELSE DO YOU WANT TO INCLUDE IN THIS LOAN?

! LAND ! HOME IMPROVEMENTS ! CREDIT CARD CONSOLIDATION

! HOME OWNER’S INSURANCE

!OTHER:____________________________

APPLICANT

CO-APPLICANT

I do not wish to furnish this information (initials) _____________

I do not wish to furnish this information (initials) _____________

! White ! Black

! American Indian or Alaskan native

! Hispanic

! White ! Black

! American Indian or Alaskan native

! Hispanic

! Asian or Pacific Islander ! Other

! Asian or Pacific Islander ! Other

SEX: ! Male

! Female

SEX: ! Male

! Female

Applicant’s Signature

Date

Co-Applicant’s Signature

Date

Customer Names: _____________________________________________________

and spoke with: _________________

Best time to call: ________________

Home Phone: ________________ Cell Phone: ________________

Email Address: ______________________________________________

Year: ________ Width: _____

Length: _________ Mfgr: _______________________

Model: ______________

**************************

REFINANCELOANINFORMATION

**************************

Orig. Sale Price of Home (include Sales Tax if any): ________________________________

Amount Financed: _____________

Estimated Payoff: ________________

When purchased: ____________________________________

Whose names are on the title of the home: _________________________________________

Current Lien holder: ____________________________________

Current Int. Rate: __________

Fixed

Variable

Balloon

Original Term: __________ months Remaining Term: ___________ months

Monthly Payment ____________

Is insurance included with payment: ________

**************************

HOMEPURCHASEINFORMATION

**************************

Who are you buying home from:

Name: ___________________________________________ City & State: ___________

Salesman: _____________

Phone: ______________________ Email: ____________________________________________

**************************

HOMELOCATIONINFORMATION

**************************

Subject Property Address: _________________________________________________________________________________

Will this be the primary residence:

YES _____

NO _______

Does customer own land:

YES _____

NO _______

Tax Appraisal Value: $ _________________________________

How many Acres: ____________ (minimum size required is 1/4 acre)

Does property have a public maintained road frontage:

YES _____

NO _______

Is property located on a paved road:

YES _____

NO _______

Type of Land:

Community w/Agreement

Family Land

Park

Private Property

Reservation

Other

Pmt/Lot Rent $_______ per month

Park Name: ___________________________________

When was the land purchased: _______________

Is the Land Financed: ___ Yes, with mobile home

___ Yes, separate loan

___ No

Whose name is on the Deed: _______________________________________________________________

What was the land purchase price: $ _____________

Estimated Payoff Amount $ _____________

Who is the lender for the land loan: ________________ Land Loan Interest Rate: Fixed

Variable

Balloon

Land Loan Original Term: _______________

Land Loan Remaining Term: _______________

Will the customer consider Land/Home combination loan: _________Yes _________No

Unit Status: New

Used

**************************

REQUESTEDLOANTERMS

**************************

HomeOnly ____________________ Home&LandOnly ____________________

LandOnly ____________________

A. Purchase of Home:

$ _____________________

I. Consolidation Request(s)

B. Refinance Home:

$ _____________________

1. _____________________

$__________________

C. Land Purchase

$ ______________________

2. _____________________

$__________________

D. Land Refinance

$ ______________________

3. _____________________

$__________________

E. Land/Home Purchase

$ _____________________

4. _____________________

$__________________

F. Land/Home Refinance

$ _____________________

J. Cash Out Request

$ _________________

G. Improvement Request(s)

1. _____________________

$__________________

K. Down Payment _____% Total Down Payment $ ____________

2. _____________________

$__________________

3. _____________________

$__________________

4. _____________________

$__________________

EstimatedTotalLoanAmount(A-JLessK):____________________

H. Move/Set Up Costs

$ __________________

(Less Down Pmt. & Fees)