Loan Application

Quick Loan Application

Completing this form does not guarantee or lock in any type of rate protection. All
applications for loans must have verbal confirmation from a Statewide Home Mortgage
Loan Officer. Please call us to lock in rate and confirm we received your application.
Please fill out this form completely. This will help us determine the best loan.

By submitting this form, you are authorizing Statewide Home Mortgage Incorporated to check
your credit, business, and employment status and history as needed for this application.

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Please provide the following contact information:
Note: Required Items are in red.

First Name:
Last Name:
Spouse's First Name:
Street Address:
City/Town:
State:
Zip/Postal Code:
Home Phone (Area Code)-Number:
Work Phone (Area Code)-Number:
Spouse Work Phone (Area Code)-Number:
Fax Phone (Area Code)-Number:
E-mail:
Fair Market Value:
1st Mortgage Balance:
2nd Mortgage Balance:
Credit History:	Excellent Good Fair Poor
Bankruptcy:	Yes No If yes, what year?
Foreclosure:	Yes No If yes, what year?
Self-Employed?	Yes No
Employer:
How Long:
Income:
Income Type:	Salary Commission
Spouse Self-Employed?	Yes No
Spouse Employer:
How Long:
Spouse Income:
Spouse Income Type:	Salary Commission
Additional Income/Amount:
Own Other Property:	Yes No
Total Monthly Expenses, less rent:
Additional Comments:	Other pertaining information

Submitting this application does not lock-in rates as posted. All applications must
be confirmed verbally.

Call Statewide Home Mortgage to confirm our receipt of your loan application
Toll Free at 1-800-551-5771 or Phone 419-927-5147.