This form will allow you to complete a mortgage application on-line for the purpose of a home purchase, refinance, or pre-qualification and send the file by e-mail to begin your loan application process.

REMEMBER:This form is unsecured.
Its purpose is intended to expedite your loan process.

Uniform Residential Loan Application
(FNMA 1003)

This application is designed to be completed by the applicant(s) . Co-Borrower information must also be provided (and the appropriate box selected below) when:

the income or assets of a person other than the "Borrower" (including the Borrowers spouse) will be used as a basis for loan qualification or
the income or assets of the Borrowers spouse will not be used as a basis for loan qualification, but his or her liabilities must be considered because the Borrower resides in a community property state, or the security property is located in a community property state, or the Borrower is relying on other property located in a community property state as a basis for repayment of the loan.

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The name of the person completing this form is :

Your e-mail address is :

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I. TYPE OF MORTGAGE AND TERMS OF LOAN

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Amount: $ No. of Months: 360 300 240 180 120 Amortization Type: Fixed Rate Graduated Pmt (GPM) Adjustable Rate (ARM) Other

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II. PROPERTY INFORMATION AND PURPOSE OF LOAN

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Property Address:

Street:

City:

State: CT FL MA ME NH VT

Zip:

No. of Units:	Year Built:
Purpose of Loan: Purchase Construction Permanent Construction Refinance Other	Property will be: Primary Residence Secondary Residence Investment

Complete this line if this is a refinance loan.

Year Acquired	Original Cost	Existing Liens	Purpose of Refinance
	$	$

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III. BORROWER INFORMATION

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Borrower		Co-Borrower
Name (include Jr. or Sr. if applicable)		Name (include Jr. or Sr. if applicable)
Social Sec. No.	Home Phone	Social Sec. No.	Home Phone
Age	Yrs. of School	Age	Yrs. of School
Marital Status Married Unmarried Separated	Dependents No. Ages	Marital Status Married Unmarried Separated	Addl. Dependents No. Ages
Present Address:		Present Address:
Street	City	Street	City
State	Zip	State	Zip
Own Rent	No. Yrs.	Own Rent	No. Yrs.
IF AT PRESENT ADDRESS LESS THAN TWO YEARS ...
Former Address:		Former Address:
Street	City	Street	City
State	Zip	State	Zip
Own Rent	No. Yrs.	Own Rent	No. Yrs.

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IV. EMPLOYMENT INFORMATION

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Borrower		Co-Borrower
Name of Employer:		Name of Employer:
Attn.:		Attn.:
Address:		Address:
City:		City:
State:	Zip:	State:	Zip:
Self-employed Yes No	Years on this job:	Self-employed Yes No	Years on this job:
Yrs. in current profession:		Yrs. in current profession:
Position/Title/Type of Bus:		Position/Title/Type of Bus:
Business Phone:		Business Phone:
IF EMPLOYED IN CURRENT POSITION FOR LESS THAN TWO YEARS...
Name of Employer:		Name of Employer:
Attn.:		Attn.:
Address:		Address:
City:		City:
State:	Zip:	State:	Zip:
Self-employed Yes No	From - To:	Self-employed Yes No	From - To:
Monthly Income:	$	Monthly Income:	$
Position/Title/Type of Bus:		Position/Title/Type of Bus:
Business Phone:		Business Phone:

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V. MONTHLY INCOME & COMBINED HOUSING EXPENSE INFORMATION

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Gross Monthly Income Borrower Co-Borrower Base Empl, Income* Overtime Bonuses Commissions Dividends/ Interest Net Rental Income Other *Self Employed Borrowers(s) may be required to provide additional documentation such as tax returns and financial statements.

Combined Mthly Exp. (Housing) Present Proposed Rent First Mortgage Other Financing Hazard Insurance Real Estate Taxes Mortgage Insurance Homeowner Assn. Dues Other

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VI. ASSETS AND LIABILITIES

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ASSETS
Completed	Jointly Not Jointly
Cash deposit held by: (for purchase only)	Amount: $
Checking/Savings Accounts
Name of Bank/S&L/Credit Union: Address: City: State: Zip: A/C No.: Balance:	Name of Bank/S&L/Credit Union: Address: City: State: Zip: A/C No.: Balance:
Name of Bank/S&L/Credit Union: Address: City: State: Zip: A/C No.: Balance:	Name of Bank/S&L/Credit Union: Address: City: State: Zip: A/C No.: Balance:
Name of Bank/S&L/Credit Union: Address: City: State: Zip: A/C No.: Balance:	Stocks and Bonds: Company name/number & description: Amount: Company name/number & description: Amount: Company name/number & description: Amount:
Vested Interest in Retirement Fund: $ Automobiles: Year & Make: Value: $ Year & Make: Value: $	Other Assets: (e.g. Furniture, Jewelry, Household Goods, Personal Property, etc.) $

Liabilities
Enter only if this is a refinance loan (details of first mortgage on subject property): First Mortgage Creditor: Name Loan Number Address City State Zip Monthly pmt. Balance
Details of second mortgage on subject property (if any): Second Mortgage Creditor: Name Loan Number Address City State Zip Monthly pmt. Balance
All other monthly liabilities: (Include credit card debt, auto loans, student loans, installment loans etc.) You may use an estimate; we will obtain details from your credit report. Monthly pmt. Balance

OTHER REAL ESTATE OWNED (Enter total for all properties not including subject property)

Market Value

Amt. of Liens

Gross Income

Mortgage Pmt

Tax/Ins. Maint.

Net Rental Inc

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VIII. DECLARATIONS

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Items	Borrower	Co-Borrower
a. Are there any outstanding judgments against you?	Y N	Y N
b. Have you been declared bankrupt within the last 7 years?	Y N	Y N
c. Have you had property foreclosed upon in the last 7 years?	Y N	Y N
d. Are you a party to a lawsuit?	Y N	Y N
e. Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment?	Y N	Y N
f. Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond or loan guarantee?	Y N	Y N
g. Are you obligated to pay alimony child support or separate maintenance?	Y N	Y N
h. Is any part of the down payment borrowed?	Y N	Y N
i. Are you the co-maker or endorser on a note?	Y N	Y N
j. Are you a U.S. citizen?	Y N	Y N
k. Are you a permanent resident alien?	Y N	Y N
l. Do you intend to occupy the property as your primary residence?	Y N	Y N
m. Have you had an ownership interest in a property in the last 3 years?	Y N	Y N

If the answer to m above is "yes":

1. What type of property did you own?	Principal residence Second home Investment Property	Principal residence Second home Investment Property
2. How did you hold title to the home?	Solely by yourself Jointly w/ spouse Jointly w/ another person	Solely by yourself Jointly w/ spouse Jointly w/ another person

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IX. ACKNOWLEDGMENT AND AGREEMENT

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The undersigned specifically acknowledge(s) and agree(s) that: (1) the loan requested by this application will be secured by a first mortgage or deed of trust on the property described herein: (2) the property will not be used for any illegal or prohibited purpose or use: (3) all statements made in this application are made for the purpose of obtaining the loan indicated herein: (4) occupation of the property will be as indicated above: (5) verification or re-verification of any information contained in this application may be made at any time by the Lender, its agents, successors and assigns, either directly or through a credit reporting agency, from any source named in this application, and the original copy of this application will be retained by the Lender, even if the loan is not approved: (6) the Lender, its agents, successors and assigns will rely on the information contained in the application and I/we have a continuing obligation to amend and/or supplement the information provided in this application if any of the material facts which I/we have represented herein have changed prior to closing: (7) in the event my/our payments on the loan indicated in this application become delinquent, the Lender, its agents, successors and assigns, may, in addition to all their other rights and remedies, report my/our name(s) and account information to a credit reporting agency: (8) ownership of the loan may be transferred to an agent, successor or assign of the Lender with prior notice to me: (9) the Lender, its agents, successors and assigns make no representations or warranties, express or implied, to the Borrower(s) regarding the property, the condition of the property, or the value of the property.

Certification: I/We certify that the information provided in this application is true and correct as of the date set forth opposite my/our signature (acknowledgment indicated below) on this application and acknowledge my/our understanding that any intentional or negligent misrepresentation(s) of the information contained in this application may result in civil liability and/or criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of title 18, United States Code, Section 1001, et seq. and liability for monetary damages to the Lender, its agents, successors and assigns, insurers and any other person who may suffer any loss due to reliance upon any misrepresentation which I/we made on this application.

Borrower's Acknowledgment Co-Borrowers Acknowledgment

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X. INFORMATION FOR GOVERNMENT MONITORING PURPOSES

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This information is entirely optional.

Borrower	Co-Borrower
I do not wish to furnish this information Race/National Origin: American Indian/Alaskan Native Asian or Pacific Islander Black Hispanic White Other Sex: Female Male	I do not wish to furnish this information Race/National Origin: American Indian/Alaskan Native Asian or Pacific Islander Black Hispanic White Other Sex: Female Male

Additional information you require may be typed in the space provided below to assist us in processing your loan request (preferred loan programs, special requirements regarding your purchase, refinance, pre-qualification, etc.):

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