Refinance Loan Application Form - Ernest Nichols III

This form will take approximately 20 – 30 minutes to complete.

Note: *ALL fields are required to be answered, and if it does not pertain to you, then please enter N/A for not applicable.

Your personal information is secure and is only used for your loan transaction. We will not use, sell, trade or rent your personal information to any other entity.

Who referred you to this loan application?*

Please enter the full name and phone number who referred you to us so we may thank them.

Reason for refinance?

What is the subject property address to refinance?

Subject Property Address:

Unit Designator:

Unit Number

City:

State:

Zip Code:

What type of home is Subject Property?

How is this property occupied?

How much do you think your subject property is worth?

IMPOUND ACCOUNTS

For more information on Impound Accounts click here

Do you want Impound Accounts on Property Taxes and Home Insurance?

If property is an investment property, how much will you receive for rents per month?

Borrowers Information:

Full Name of Borrower (include Sr, Jr, II, III etc):

Social Security Number:

Date of Birth (MM/DD/YYYY):

Type of Citizenship

Non-Permanent Resident Alien

Alternate Names (also known as), if any. For example, previous maiden name or any previous legal names used other than what you listed above?

Home Phone Number:

Cell Phone Number:

Email Address:

Marital Status

If Unmarried, is there a person who is not your legal spouse, but who currently has real property rights similar to those of a legal spouse?

i.e. Civil Union, Domestic Partnership, Registered Reciprical Beneficiary Relationship or Other.

If Unmarried - Yes

If other, please indicate for which state(s) was it filed?

If Separated, have you filed legal separation with the courts?

Number of Dependents:

Enter ages of each dependent followed by commas.

CURRENT ADDRESS of where you physically live (no PO Box or UPS Store address):

Current Address:

Unit Designator:

Unit Number

City:

State:

Zip Code:

Do you Own or Rent?

If Rent, how much do you pay per month?

Please enter the reason for "None."

How much do you pay per month?

How long have you lived at this current address? (Input in YEARS and/or MONTHS, i.e. 1 year and 6 months).

Were you living at the above current address equal to or more than 2 years?

Please enter PREVIOUS address of where you lived:

Unit Designator:

Unit Number

City:

State:

Zip Code:

How long have you lived at the previous address? (Input in YEARS and/or MONTHS, i.e. 1 year and 6 months).

If you combined the total time for both Current Address and Previous Address of where you lived, how much does it equal to?

Please enter PREVIOUS address #2 of where you lived:

Unit Designator:

Unit Number

City:

State:

Zip Code:

How long have you lived at the PREVIOUS address #2? (Input in YEARS and/or MONTHS, i.e. 1 year and 6 months).

What is your Mailing Address?

Other, please enter the address:

Unit Designator:

Unit Number

City:

State:

Zip Code:

Preferred Language:

EMPLOYMENT, SELF-EMPLOYMENT OR OTHER INCOME:

Are you employed as W-2 Employee?

How long have you worked with your current employer?

What is the name of your Current Employer?

What is the address of your Current Employer?

Unit Designator:

Unit Number

City:

State:

Zip Code:

Position or Job Title:

Phone number of HR or Supervisor that can verify your employment:

Start Date, please enter (mm/dd/yyyy) or use the Calendar:*

How long did you work in this same line of work? (Years/Months)

What is the name of your Current Employer?

What is the address of your Current Employer?

Unit Designator:

Unit Number

City:

State:

Zip Code:

Position or Job Title:

Phone number of HR or Supervisor that can verify your employment:

Start Date, please enter (mm/dd/yyyy) or use the Calendar:*

How long did you work in this same line of work? (Years/Months)

What is the name of your PREVIOUS Employer?

What is the address of your PREVIOUS Employer?

Unit Designator:

Unit Number

City:

State:

Zip Code:

Position or Job Title:

Phone number of HR or Supervisor that can verify your PREVIOUS employment:

Start Date, please enter (mm/dd/yyyy) or use the Calendar:*

End Date, please enter (mm/dd/yyyy) or use the Calendar:*

If you combined both Current Employer and Previous Employer together, does it equal to or more than 2 years?

What is the name of your PREVIOUS Employer #2?

What is the address of your PREVIOUS Employer #2?

Unit Designator:

Unit Number

City:

State:

Zip Code:

Position or Job Title:

Phone number of HR or Supervisor that can verify your PREVIOUS Employment #2:

Start Date, please enter (mm/dd/yyyy) or use the Calendar:*

End Date, please enter (mm/dd/yyyy) or use the Calendar:*

Are you Employed by a family member, property seller, real estate agent, or other party to the transaction?

Are you a Business Owner and/or Self-Employed (Schedule C or Schedule E)?

What is your Ownership Share?

What is your Ownership Share of your Schedule C business?

What is your Ownership Share of your Schedule E business?

Do you have Foreign Income?

Do you have Seasonal Income (ie Farmer, W-2 Contract Employee)?

Do you receive Unemployment Income from EDD during non-working season?

Do you have income from Other Sources?

If you answered yes, select below:

How much per month?

Do you have 2nd income from Other Sources?

If you answered yes, select below:

How much per month?

Do you have 3rd income from Other Sources?

If you answered yes, select below:

How much per month?

Do you have 4th income from Other Sources?

If you answered yes, select below:

How much per month?

Do you have 5th income from Other Sources?

If you answered yes, select below:

How much per month?