Mortgage Application PremierBank

PremierBank is based in Fort Atkinson, Wisconsin and has physical locations in Jefferson, Rock, and Walworth Counties focusing on lending to people in the south central Wisconsin area.

Mortgage Loan Application

($) Loan Amount

($) Purchase Price (if applicable)

Term

Which loan officer are you currently working with?(Required)

Purpose of the Loan

Purchase

Purchase Vacant Land

Construction

Refinance

Home Equity Loan (Not Line of Credit)

Will this application be completed individually or jointly?

Individually

Jointly

Property Information

Is this a pre-qualification?

Yes

If this is a pre-qualification request, please select “Yes” and go directly to the Borrower Information section. If your request is not a pre-qualification, please select “No” and complete the Property Information below.

Property Address

Street Address City State / Province / Region ZIP / Postal Code

Number of Units

Is this a refinance transaction?

Yes

If this is a refinance transaction, please complete the following

Year Acquired

($) Original Cost

($) Amount of Existing Liens

Purpose of Refinance

Improvements

Made since purchase or

To be made with loan proceeds

Describe Improvements

Borrower information

Name of Borrower #1

Date of Birth

Social Security Number

Driver's License Number

Home Phone

Cell Phone

Email Address

Select Marital Status

Address

Street Address City State / Province / Region ZIP / Postal Code

Years at this Address

Do you rent or own?

Rent

Own

Have you lived here for less than two years?

Yes

Address

Street Address City State / Province / Region ZIP / Postal Code

Is your mailing address different than your home address?

Yes

Address

Street Address City State / Province / Region ZIP / Postal Code

Dependents

Number of Dependents

Ages of Dependents

Employment

Employer Name

First Last

Select Years on the Job

Years in this line of work or profession

Title/Type of Business

Employer Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Employer Phone

Have you worked here for less than two years?

Yes

Previous Employer

Financial Information

Please note: Alimony, child support or separate maintenance income need not be revealed if the borrower (B) or co-Borrower (C) does not choose to have it considered for repaying this loan. Also self employed borrowers may be required to provide additional documentation such as tax returns and financial statements. (before taxes)

Gross Monthly Income (Assets)

($) Borrower Income

($) Other Income (if any)

Type

($) Other Income (if any)

($) Co-Borrower Income

Type

Current Monthly Housing Expenses

($) Rent

($) First Mortgage

($) Second Mortgage

($) Hazard Insurance

($) Property Taxes

($) Hazard Insurance

($) Property Taxes

($) Mortgage Insurance

($) HOA Dues

List Checking & Savings Account Information Below

Bank Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Account Number

($) Account value

Account #2

Bank Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Account Number

($) Account value

Account #3

Bank Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Account Number

($) Account value

Real Estate Owned

Property Address

Street Address City State / Province / Region ZIP / Postal Code

($) Estimated Value

Additional Assets

Stocks & Bonds Description

($) Value

($) Life Insurance Face Amount

($) Cash Value

($) Vested interest in retirement plan

($) Net worth of business owned

Automobiles

Car #1 Make

Year

(S) Value

Car #2 Make

Year

(S) Value

Other Assets

Other Asset

($) Value

Other Asset

($) Value

Current Monthly Payments: (Liabilities)

Name of Company

($) Payment

Name of Company

($) Payment

Name of Company

($) Payment

Name of Company

($) Payment

Name of Company

($) Payment

Name of Company

($) Payment

Name of Company

($) Payment

Declarations

a. Are there any judgments against you?

Borrower

Yes

Co-Borrower

Yes

b. Have you been declared bankrupt within the past 7 years?

Borrower

Yes

Co-Borrower

Yes

c. Have you had property foreclosed on or given title or deed in lieu of w/i 7 years?

Borrower

Yes

Co-Borrower

Yes

e. Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer or title in lieu of foreclosure or judgment? (this would include such loans as home mortgage loans, SBA loans, home improvement loans, educational loans, manufactured (mobile) home loans, any mortgage financial obligation, bond or loan guarantee. If yes please provide details, including name & address of lender, FHA or VA case number, if any, and give reasons for the action below)

Borrower

Yes

Co-Borrower

Yes

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 below

Borrower

Yes

Co-Borrower

Yes

g. Are you obligated to pay alimony, child support or separate maintenance?

Borrower

Yes

Co-Borrower

Yes

h. Is any part of the down payment borrowed?

Borrower

Yes

Co-Borrower

Yes

i. Are you a co-maker or endorser on a note?

Borrower

Yes

Co-Borrower

Yes

j. Are you a U.S. citizen

Borrower

Yes

Co-Borrower

Yes

k. Are you a permanent resident alien?

Borrower

Yes

Co-Borrower

Yes

I. Do you intend to occupy the property as your primary residence? (if yes complete question M

Borrower

Yes

Co-Borrower

Yes

m. Have you had ownership interest in a property in the last three years?

Borrower

Yes

Co-Borrower

Yes

(1) What type of property did you own?

(2) How did you hold title to the home?

Please let us know any comments and the best method of contacting you.

Demographic Information Borrower (s)

The purpose of collecting this information is to help ensure that all the applicants are treated fairly and that the housing needs of communities and neighborhoods are being fulfilled. For residential mortgage lending, Federal law requires that we ask applicants for their demographic information (ethnicity, sex, and race) in order to monitor our compliance with equal credit opportunity, fair housing, and home mortgage disclosure laws. You are not required to provide this information, but are encouraged to do so. You may select one or more designations for "Ethnicity" and one or more designations for "Race." The law provides that we may not discriminate on the basis of this information, or on whether you choose to provide it. However, if you choose not to provide the information and you have made this application in person, Federal regulations require us to note your ethnicity, sex, and race on the basis of visual observation or surname. The law also provides that we may not discriminate on the basis of age or marital status information you provide in this application. If you do not wish to provide some or all of this information, please check below.

Other Hispanic or Latino - Print origin:

Print name of enrolled or principal tribe

Other Asian - Print Race:

Other Pacific Islander - Print race:

Sex

Female

Male

I do not wish to provide this information

Co-Borrower

Other Hispanic or Latino - Print origin:

Print name of enrolled or principal tribe

Other Asian - Print Race:

Other Pacific Islander - Print race:

Sex

Female

Male

I do not wish to provide this information

Important Information About Procedures for Opening a New Account

To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents. You will be required to come into one of our locations to complete the loan process. (Sign loan papers, verify information, etc.)

Privacy Policy Information(Required)

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You must choose one of the following options

Banking Sign In

Mortgage Loan Application

Mortgage Loan Application

Property Information

If this is a refinance transaction, please complete the following

Borrower information

Dependents

Employment

Financial Information

Gross Monthly Income (Assets)

Current Monthly Housing Expenses

List Checking & Savings Account Information Below

Account #2

Account #3

Real Estate Owned

Additional Assets

Automobiles

Other Assets

Current Monthly Payments: (Liabilities)

Declarations

Demographic Information Borrower (s)

Important Information About Procedures for Opening a New Account