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                             "The Easy Loan"
 

Please tell us at least one way to contact you
First Name:
Middle Name:
Last Name:
Email:
Phone Day: --   Ext.
Phone Evening: --
Referred By:

This loan is not only easy to get, it's easy to apply for...

Just tell us a little more
Marital Status:
Resident Status:
Date of Birth: //
SSN: --
Dependents: Number:   Age(s) (separated by comma): 
Present Address:
    Street:
    City:
    State:  Zip:  
  Ownership:    years
Former Address (Needed if residing at present address for less than 2 years):
    Street:
    City:
    State:  Zip:  
  Ownership:    years
 
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 federal regulations the lender is required to note ethnicity, race, and sex on the basis of visual observation or surname.
I do not wish to furnish this information  
 
  Ethnicity:
  Race:
  American Indian or Alaska Native
  Asian
  Black or African American
  Native Hawaiian or Other Pacific Islander
  White
 
  Sex: Female Male
 
Monthly Income:
    Base:
    Bonus:
    Commision:
    Other:
Assets:
    Checking:
    Savings:
    401k:
    Other:

A bit about the subject property
Property Usage:
Purpose of Loan:
Purpose of Refinance:
Loan Amount:
Property Value:
Number of Units:
Year Built:
Address of Subject Property:
    Street:
    City:
    State:  Zip: 

Complete only if you have a co-borrower
  Check this box if the coborrower is the spouse of the primary borrower
First Name:
Middle Name:
Last Name:
Email:
Phone Day: --   Ext.
Phone Evening: --
Marital Status:
Resident Status:
Date of Birth: //
SSN: --
Dependents: Number:   Age(s) (separated by comma): 
Present Address:
    Street:
    City:
    State:  Zip:  
  Ownership:    years
Former Address (Needed if residing at present address for less than 2 years):
    Street:
    City:
    State:  Zip:  
  Ownership:    years
 
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 federal regulations the lender is required to note ethnicity, race, and sex on the basis of visual observation or surname.
I do not wish to furnish this information  
 
  Ethnicity:
  Race:
  American Indian or Alaska Native
  Asian
  Black or African American
  Native Hawaiian or Other Pacific Islander
  White
 
  Sex: Female Male
 
Monthly Income:
    Base:
    Bonus:
    Commision:
    Other:
Assets:
    Checking:
    Savings:
    401k:
    Other: