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Please complete the following information to the best of your ability. If you cannot complete one of thequestions for whatever reason please move on to the questions you can answer, we will contact you if additional information is required. 

You may submit this application electronically or you may print it out and submit it by fax to (800) 449-4041. Please don't hesitate to contact us with any questions you may have. Thank you for choosing Rosemont Mortgage.

Privacy Statement

Uniform Residential Loan Application

This application is designed to be completed by the applicant(s) with the lender's assistance. Applicants should complete this form as "Borrower" or "Co-Borrower" as applicable. Co-Borrower information must also be provided (and the appropriate box checked) when the income or assets of a person other than the "Borrower"(including the Borrower's spouse) will be used as a basis for loan qualification or the income or assets of the Borrower's spouse will not be used as a basis for loan qualification, but his or her liabilities must be considered because the Borrower resides in a community property state, the security property islocated in a community property state, or the Borrower is relying on other property located in a community property state as a basis for repayment of the loan.

TYPE OF MORTGAGE AND TERMS OF LOAN
Amount
$ 		Interest Rate
%		 Months
 Mortgage Applied for: V.A. Conventional FHA  Other
Amortization Type: Fixed Rate Other GPM ARM
PROPERTY INFORMATION AND PURPOSE OF LOAN
Subject Property Address (street, city, state, zip)

 County

 No. of Units
Legal Description of Subject Property (attach description if necessary)
 Year Built
Purpose of Loan: Purchase Refinance Construction Construction Permanent Other
Property will be: Primary Residence Secondary Residence Investment
BORROWER INFORMATION Co-Borrower
Borrower EMail:
Co Borrower EMail:
Social Sec #
 Home Phone
  Age
 School
 Social Sec #
 Home Phone
 Age
 School
Married Separated
Unmarried		 Dependents
No.      Ages
     		Married Separated
Unmarried		 Dependents
No.      Ages
   
Present Address (street, city, state, zip)


Own  Rent   No. Yrs.		 Present Address (street, city, state, zip)


Own  Rent   No. Yrs.
Borrower EMPLOYMENT INFORMATION Co-Borrower
Name and Address of Employer



  		Yrs. on Job

Yrs in this line of profession:
Self Employed		 Name and Address of Employer



  		Yrs. on Job

Yrs in this line of profession:


Self Employed
Position/Title/Type of Business
 Business Phone

 Position/Title/Type of Business
 Business Phone
If employed for less than two years or if employed in more than one position, complete the following:
Name and Address of Employer



  		From            To
 
Monthly Income
$
Self Employed		 Name and Address of Employer



  		From            To
 
Monthly Income
$
Self Employed
Position/Title/Type of Business
 Business Phone

 Position/Title/Type of Business
 Business Phone
MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION
Gross Monthly
Income		 Borrower Co-Borrower Total Housing Expenses Present Proposed
Base Employ. Income* $ $ $ Rent $
Overtime $ $ $ First Mortgage(P&I) $ $
Bonuses $ $ $ Other Financing(P&I) $ $
Commissions $ $ $ Hazard Insurance $ $
Dividends/Interest $ $ $ Real Estate Taxes $ $
Net Rental Income $ $ $ Mortgage Insurance $ $
Other $ $ $ Homeowner Assn. Dues $ $
$ $ $ Other $ $
Total $ $ $ Total $ $
*Self employed borrower(s) may be required to provide additional documentation such as tax returns & financial statements.
ASSETS AND LIABILITIES
This statement and any applicable supporting schedules may be completed jointly by both married and unmarried co-borrowers if their assets and liabilities are sufficiently joined so that the statement can be meaningfully and fairly presented on a combined basis; otherwise separate statements and schedules 
are required. If the co-borrower section was completed about a spouse, this statement and supporting schedules must be completed about the spouse also.

ASSETS

 Cash or Market Value Liability and Pledged Assets. List the creditors name, address and account # for all outstanding debts,including auto loans, revolving charge accounts, real estate loans, alimony, child support, stock , etc.
Cash Deposit Purchase Held by:

Amount:

$

LIABILITIES Monthly Pmt/
Unpaid
Balance
Name and address of Bank, SL or Credit Union


 Name and address of Company


 Payment:
$
Balance:
$
Acct. no. Balance
$ 		Acct. no.
Name and address of Bank, SL or Credit Union


 Name and address of Company


 Payment:
$
Balance:
$
Acct. no. Balance
$ 		Acct. no.
Name and address of Bank, SL or Credit Union


 Name and address of Company


 Payment:
$
Balance:
$
Acct. no. Balance
$ 		Acct. no.
Stocks and Bonds
$
$
$
 
$
  
   		Name and address of Company


 Payment:
$
Balance:
$
Life insurance net cash value
Face amount $ 		Balance
$ 		Acct. no.
Subtotal Liquid Assets $ Name and address of Company


 Payment:
$
Balance:
$
Retirement Fund $
Real Estate Owned: $ Acct. no.
Automobiles Owned:


  
$
$
$ 		Name and address of Company


 Payment:
$
Balance:
$
Net Worth of business(es): $ Acct. no.
Other Assets:


  
$
$
$ 		Alimony/Child Support/separate Maintenance: $
Job Related Expense: $
Total Monthly Payments $
Total Assets $ Total Liabilities $
DECLARATIONS
  Borrower Co-Borrower
Yes No Yes No
a. Are there any outstanding judgments against you?
b. Have you been declared bankrupt within the past 7 years?
c. Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?
d. Are you a party to a lawsuit?
e. Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment? (This would include such loans as home mortgage loans, SBA loans, home improvement loans, educational loans, manufactured home loans, any mortgage, financial obligation. bond, or loan guarantee.)
f. Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond or loan guarantee?.
g. Are you obligated to pay alimony, child support, or separate maintenance?
h. Is any part of the down payment borrowed?
i. Are you the co-maker or endorser on a note?
j. Are you a U.S. citizen?
k. Are you a permanent resident alien?
l. Do you intend to occupy the property as your primary residence?
m. Have you had an ownership interest in a property in the last three years?
(1) What type of property did you own - principal residence (PR), second home (SH), or investment property (IP)?

(2) How did you hold title to the home - solely by yourself (S), jointly with your spouse (SP), or jointly with another person (O)?

ACKNOWLEDGMENT AND AGREEMENT

The undersigned specifically acknowledge(s) and agree(s) that:(1) The loan requested by this application will be secured by a first mortgage or deed of trust on the property described herein (2) the property will not be used for any illegal or prohibited purpose or use; (3) all statements made in this application are made for the purpose of obtaining the loan indicated herein; (4) occupation of the property will be as indicated above; (5) verification or re-verification of any information contained in the application may be made at any time by the lender, it's agents, successors and assigns, either directly or through a credit reporting agent, from any source named in this application, and the original copy of this application will be retained by the lender, even if the loan is not approved; (6) the lender, it's agents, successors and assigns will rely on the information contained in the application and I/we have a continuing obligation to amend and/or supplement the information provided in this application if any of the material facts which I/we have represented herein should change prior to closing; (7) in the event my/our payments on the loan indicated in this application become delinquent, the lender, it's agents, successors and assigns, may, in addition to all their other rights and remedies, report my/our name(s) and account information to a credit reporting agency; (8) ownership of the loan may be transferred to successor or assign of the lender without notice to me and/or the administration of the loan account may be transferred to an agent, successor or assign of the lender with prior notice to me; (9) the lender, it's agents, successors and assigns make no representations or warranties, expressed or implied, to the borrower(s) regarding the property, the condition of the property, or the value of the property.

Right to Receive Copy of Appraisal. I/We have the right to a copy of the appraisal report used in connection with this application for credit. To obtain a copy, I/We must send Lender a written request at the mailing address Lender has provided. Lender must hear form me/us no later than 90 days after Lender notifies me/us about the action taken on this application, or I/We withdraw this application.

Certification: I/we certify that the information provided in this application is true and correct as of the date set forth opposite my/our signature(s) on this application and acknowledge my/our understanding that my intentional or negligent misrepresentation(s) of the information contained in this application may result in civil liability and/or criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of title 18, United States Code, Section 1001, et sec. and liability for monetary damages to the lender, it's agents, successors and assigns, insurers and any other person who may suffer any loss due to the reliance upon any misrepresentation which I/we have made on this application.
Borrower's Signature
X 		Date
 Co-Borrower's Signature
X 		Date