Complete this form to receive up to 3 offers on your purchase, refinance, debt consolidation or equity loan.
    
Lenders Are Licensed In The Following States

Alabama

Indiana

Missouri

Florida

Kentucky Tennessee

Georgia

 South Carolina

Virginia

Nebraska Minnesota  
 Offering FHA, VA, Conventional and Rural Housing Mortgages
If this application is for joint credit, Borrower and Co-Borrower each agree that we intend to apply for joint credit (check here)

 

 

Borrower   Co-Borrower

 

 

* Indicates Required Fields
What Kind of Loan Are You Looking For?
Type of Loan
Residence Type:
Property Type:
Number of Units:
Length of loan desired?
Sales Price or Home-Value if Refi:
Estimated Loan Amount ($) *:
 
Please Tell Us About Yourself
Applicant Name *,                Middle In.

Applicant Last Name *

Home Phone *
( ) -
Work Phone
( ) -
Social Sec. Number:
- -
Birth Date:

Dependents no.

Dependents ages
(separate with comma) 		Years of Schooling

Email *
     
Co-Applicant Name,             Middle In.

Co-Applicant Last Name

Home Phone
( ) -
Work Phone
( ) -
Social Sec. Number:
- -
Birth Date:

Dependents no.

Dependents ages
(separate with comma) 		Years of Schooling

Email
     
Current Address *

City

 State

Zip
- 		Length of time at address
 Years    Months
Mailing Address (Same Address as above )
Address

City

 State

Zip
-
 
     
Employment Information

1.		 Applicant Employer

Position
 Years on Job

Years in same field
 Monthly Income ($)

2.		 Co-Applicant Employer

Position

 Years on Job

Years in same field
 Monthly Income ($)
Income from alimony, child support or separate maintenance payments need not be revealed, if you do not choose to have it considered as a basis for repaying this debt.
3. Other Income Applicant
 Monthly Income ($)
  
4. Other Income Co-Applicant
 Monthly Income ($)
  
       
Total Gross Monthly Income ($):  
     
Your Assets
1. Cash Deposit (Account Type)
 Amount ($)
  
2.  
       
1. Checking and Savings Accounts
Financial Institution
 Amount ($)
 Account Number
2. Financial Institution
 Amount ($)
 Account Number
       
1. Stocks & Bonds (Description)
 Amount ($)
  
2.  
3.  
       
1. Life Insurance
 Face Amount ($)
  
       
1. Automobile Type
 Est. Value ($)
  
2.  
3.  
       
1. Other Assets (Description)
 Amount ($)
  
2.  
3.  
4.  
       
Please Describe Your Housing Expenses
  Monthly Pmt ($)   Monthly Pmt ($)
1st Mortgage 2nd Mortgage
Property Taxes Home Owners Ins.
Mortgage Insurance Rent Monthly Payment
Total Current Housing Expenses:
       
Aprx. 1stMtg Balance ($): Aprx. 2ndMtg Balance ($):
Max Line of Credit ($): Aprx. Home Value ($):
Home is to be:    
       
Please list your Monthly Debts (This Section is Optional)
  Type of Liability
Account Number
 Cur. Bal. ($)
Monthly Pmt. ($)
1.
2.
3.
4.
5.

I Hereby Declare The Following

 

Borrower

Co-Borrower

Have you filed for bankruptcy in the past 7 years

 Y or N  

 Y or N   

Do you have any judgments or lliens

 Y or N  

 Y or N   

 

Information for Government Monitoring Purposes
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 not discriminate either on the basis of this information, or on whether you choose to furnish it. If you furnish this 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 the information on the basis of visual observation and surname if you have made this application in person. If you do not wish to furnish this 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 applicable state law for the particular type of loan applied for.)
Applicant
I do not wish to furnish this information:
Ethnicity
Hispanic or Latino Not Hispanic or Latino
Race
American Indian or Alaskan Native Asian Black or African American
Native Hawaiian or Other Pacific Islander White
Gender Marital Status
Co-Applicant
I do not wish to furnish this information:
Ethnicity
Hispanic or Latino Not Hispanic or Latino
Race
American Indian or Alaskan Native Asian Black or African American
Native Hawaiian or Other Pacific Islander White
Gender Marital Status
Projected date of closing & Comments
Projected date of closing  
would be: 
around:   : 
prefer contact by: 
Comments: 
How did you hear about us? 
You understand that by clicking on the I AGREE button immediately following this notice, you are providing 'written instructions' to First Commonwealth Mortgage under the Fair Credit Reporting Act authorizing First Commonwealth Mortgage to obtain information from your personal credit profile or other Information from Experian and/or other credit bureaus. You authorize First Commonwealth Mortgage to obtain such information solely in accordance with this Mortgage Loan Application.
 I Agree (or)  I Do NOT Agree
© First Commonwealth Mortgage, 2008 . All rights reserved.