Real Estate Loan Application

First Bank Kansas – Real Estate Loan Application

*Are you inquiring about Individual or Joint Credit? Joint Individual (If Joint, the co-borrower section has the same required fields as the primary borrower.) *Marital Status: Unmarried Married Separated *Purpose of Loan

*Purchase Price or Appraised Value of Property$*Loan Amount Requested$Length of loan requested(months)$Subject Property Address*Property will be:

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Primary Borrower

*Last Name
*First Name
Middle Name
*Social Security Number (TIN)
*Date of Birth / /
Number of Dependents
Ages of Dependents
Home Phone Number
Work Phone Number ext.
*Cell Phone Number
*Email Address
 

Home Address

*Address 1
Address 2
*City
*State
*Zip
Time at Current Residence Years Months
Residence Type Own Rent Other
 

Mailing Address

*Address 1
Address 2
*City
*State
*Zip
 

Previous Address (if within the last 2 years)

Address 1
Address 2
City
State
Zip
Time at Previous Residence Years Months
Residence Type Own Rent Other
 

Present Employer

Name
Phone Number ext.
Employment Status Full Time Part Time Temp Retired Other
Job Title
Job Start Date / /
Gross Salary $Per
Alimony, child support, or separate maintenance need not be revealed if you do not wish to have it considered as a basis for repaying obligation.
Other Income $Per
Other Income Source
 

Previous Employer (if within the last 2 years)

Name
Phone Number ext.
Employment Status Full Time Part Time Temp Retired Other
Job Title
Job Start Date / /
Job End Date / /
Gross Salary $Per

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Co-Borrower

*Marital Status:
Unmarried Married Separated
*Last Name
*First Name
Middle Name
*Social Security Number (TIN)
*Date of Birth / /
Number of Dependents
Ages of Dependents
*Home Phone Number
Work Phone Number ext.
Cell Phone Number
Email Address
 
 

Home Address

*Address 1
Address 2
*City
*State
*Zip
Time at Current Residence Years Months
Residence Type Own Rent Other
Monthly Payment $
 

Mailing Address

*Address 1
Address 2
*City
*State
*Zip
 

Previous Address (if within the last 2 years)

Address 1
Address 2
City
State
Zip
Time at Previous Residence Years Months
Residence Type Own Rent Other
 

Present Employer

Name
Phone Number ext.
Employment Status Full Time Part Time Temp Retired Other
Job Title
Job Start Date / /
Gross Salary $Per
Alimony, child support, or separate maintenance need not be revealed if you do not wish to have it considered as a basis for repaying obligation.
Other Income $Per
Other Income Source
 

Previous Employer (if within the last 2 years)

Name
Phone Number ext.
Employment Status Full Time Part Time Temp Retired Other
Job Title
Job Start Date / /
Job End Date / /
Gross Salary $Per

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Home Mortgage Disclosure Act (HMDA)

Please Note: 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. If you do not wish to furnish the information, please check below.

Primary Borrower

I do not wish to furnish this information
Ethnicity Hispanic or Latino Not Hispanic or Latino
Race American Indian, Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White
Sex Male Female

Co-Borrower (if applicable)

I do not wish to furnish this information
Ethnicity Hispanic or Latino Not Hispanic or Latino
Race American Indian, Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White
Sex Male Female

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Declarations

Place a check for any “Yes” answers. Leave blank for “No”. Please explain any “Yes” answers to questions a through i, in the space provided below.

Borrower Co-Borrower  
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? (If “Yes”, provide details, including date, name and address of Lender, FHA or VA case number, if any, and reasons for the action.)
f./ Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee? (If “Yes”, give details as described in the preceding question.)
g. Are you obligated to pay alimony, child support, or separate maintenance?
h. Is any part of the down payment borrowed?
i. Are you a co-maker or endorser on a note?

j. Are you a U.S. citizen?
k. Are you a permanent resident alien?
Explain any “Yes” answers here

Debts/Monthly Payments

List all other debts (for example, auto loans, credit cards, second mortgage, home assoc. dues, alimony, child support, child care, medical, utilities, auto insurance, IRS liabilities, etc.)

Debts Monthly Payments
$
$
$
$
$
$
$
$
$
$

Additional Information

How would you prefer to be contacted? Home Phone Work Phone Cell Phone Email Address Other
Name of Lender (if preference)
Special Instructions/Comments

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Please note: Income verification is required; other information may be required. I certify that statements on this application are true and complete. I authorize any person, association, firm or corporation to furnish, on request of this financial institution, information concerning me or my affairs.(Sec. 1014, Title 18, U.S. Code makes it a Federal Crime to knowingly make a false statement on this application.) A lender will contact you to discuss your loan inquiry within 1-3 business days. We look forward to working with you!

Why Choose First Bank Kansas?

1. We look for ways to say YES!

2. We make our loan decisions locally!

3. Our knowledgeable loan staff will give you personalized service.

4. We fit the loan to the need: short, long, fixed, adjustable, conventional or portfolio.

5. First Bank Kansas can maintain servicing.

6. Customers are treated like friends here. If you have a question, you can always call.

7. We live, work, volunteer and reinvest in our communities! First Bank Kansas is a Kansas-owned community bank with Midwest values.

Loans Available

Vehicle (New & Refinance)
Home (New & Refinance)
Business (Large & Small)
Agriculture
Personal
Construction
Credit Establishing
Swing or Bridge