Borrower Information Form DisclaimerDo not fill out this form unless instructed to do so by a loan officer. The loan approval department does not monitor these entries, and if you submit loan application information here, it will not be received. Click here to submit a loan application.Contact Name*Date* Date Format: MM slash DD slash YYYY Contact Email* CountyLocation of Property* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How did you hear about us?Are you borrowing as a company?*YesNoBorrower Legal Name*Borrower Mailing Address*CountyAre you married?*YesNoBorrower SSN*Spouse Name*Spouse SSN*Will anyone other than yourself be signing at closing with Power of Attorney (POA)?*YesNoBorrower Entity Name*FEIN*Borrower Mailing Address*CountyAre all Partners/Members Signing at Closing?*YesNoNumber of Partners and Members:*Company has only one Owner/Member?*YesNoSigned Operating Agreement exist?*YesNoPerson’s Name to Guarantee 1:TitleGuarantee Home Address 1:CountyPerson’s Name to Guarantee 2:TitleGuarantee Home Address 2:CountyIs Survey Available from the Seller?*YesNoIs Survey Desired (It is NOT required)?YesNoInsurance CompanyAgent NameAgent Email Agent PhoneName of Nearest Relative (Not Living With You) First Last Phone of Nearest Relative (Not Living With You)EmailThis field is for validation purposes and should be left unchanged.