Quick Loan Application

Apply On-Line

Click Here if you would prefer to print out this form and fax it in to our Toll Free Fax Number. You will need Adobe Acrobat 5.0 Free Reader - just click on the photo -

Provided to you by:
Teresa N. Snyder, Associate Real Estate Broker, GRI
& Loan Officer for UMCA (Exclusive Service reserved for real estate clients only)

Home & Loan Finder Hotline
Toll Free 1-866- 883-3421 Press # to leave a message
(541) 331-3421 Cell
teresa@t-crealty.com

Mailing Address:
Town & Country Realty
2300 Biehn Street
Klamath Falls, OR 97601

Please fill out the following information and click the submit button at the end of this form..

This information is needed before we can proceed to the next step.

Thank you for your cooperation.

Contact Information

First Name, Middle, & Last Name***

First Name, Middle, & Last Name: ***

Home Phone No + Area Code: *

Business Phone No + Area Code:

Email Address :*

I hereby grant authorization to Teresa N. Snyder to obtain a standard factual data credit report through a credit reporting agency chosen by her. I authorize the release to the credit reporting agency a copy of my credit application and authorize the credit reporting agency to obtain information regarding my employment savings accounts and outstanding credit accounts (mortgages auto loans personal loans charge cards credit unions etc.) Authorization is further granted to the reporting agency to use a photo-static reproduction of the authorization if necessary to obtain any information regarding the above mentioned information.

*Do you Agree ? Yes No

*Digital Signature: *Date:

* Denotes required field. You must provide the information requested. We will need you to mail or bring by 2300 Biehn Street, Klamath Falls, OR 97601 - Your last two months pay stubs for each borrower, last two years W-2's, 1099's or Tax Returns & 3 months Bank Statements. We can not proceed to the next step without this information - It is required by all Lenders.

Borrower Information

First Name: Middle: Last Name:

*SSN :

Home Phone No. + Area Code:

*Age: *Birthdate: (Month, day, & Year)

Yrs. School :

Marital Status:Married Separated Unmarried Single Widowed

No. Dependent:

Ages :e.g. [2][13-7]

Do you have VA Eligibility? Yes No

Are you a Disabled Vet? Yes No

*Current Address: Dates Occupied:

*City, State & Zip:*

Will Your Landlord give you a good reference? Yes No

Did you pay your rent on time? Yes No

If residing at present address for less than two years :

Previous Address: Dates Occupied:

City, State & Zip:

Will Your Landlord give you a good reference? Yes No

Did you pay your rent on time? Yes No

Borrower Employment Information

Current Employer Name:

Are You Self Employed? Yes No

Yrs. on this job: Yrs. on this Profession, :

Dates (from-to):

Current Employer Address:

City, State & Zip:

Position/Title:

Type of Business :

Business Phone No. + Area Code:

If employed in current position for less than two years or if currently employed in more than one position, complete the following:

Previous Employer Name :

Were You Self Employed? Yes No

Dates (from-to):

Monthly Income:$

Employer Address:

City, State & Zip:

Position/Title:

Type of Business :

Business Phone No. + Area Code:

Do you have a Co-Borrower ?

Yes -If Yes, Please provide the following information

No - If No, please click here to skip to Assets

Co-Borrower Information

First Name:Middle Last Name:

SSN:

Home Phone No. + Area Code:

*Age: *Birthdate: (Month, day, & Year)

Yrs. School:

Marital Status:Married Separated Unmarried Single Widowed

No. Dependent:

Ages :e.g. [2][13-7]

Do you have VA Eligibility? Yes No

Are you a disabled Vet? Yes No

Current Address: Dates Occupied:

City, State & Zip:

Will Your Landlord give you a good reference? Yes No

Have you paid your rent on time? (within 30 days of due date) Yes No

If residing at present address for less than two years :

Previous Address: Dates Occupied:

City, State & Zip:

Will Your Landlord give you a good reference? Yes No

Did you pay your rent on time? Yes No

Co-Borrower Employment Information

Current Employer Name:

Are You Self Employed? Yes No

Yrs. on this job: Yrs. on this Profession:

Dates (from-to):

Current Employer Address:

City, State & Zip:

Position/Title: Type of Business :

Business Phone No. + area code:

If employed in current position for less than two years or if currently employed in more than one position, complete the following:

Employer Name :

Are/Were You Self Employed? Yes No

Dates (from-to):

Monthly Income :$

Employer Address:

City, State & Zip:

Position/Title:

Type of Business :

Business Phone No. + Area Code:

Asset Information
Monthly Income and Combined Housing Expenses
Borrower Income
Gross Monthly Income	Base Employment Income	Overtime	Bonuses	Commissions	Dividends	Other Income

Co-Borrower Income
Gross Monthly Income	Base Employment Income	Overtime	Bonuses	Commissions	Dividends	Other Income

Current Monthly Housing Expenses
	Rent	First Mortgage	Other Mortgages	Hazard Insurance	Real Estate Taxes	Home Owner Assn Dues

Assets A. Checking and Saving Accounts - We will not ask for account numbers. If the Lender requests them, we will contact you.
Name of Bank, S&L, or Credit Union	Address of Bank, S&L, or Credit Union	Acct Type, and Balance (Checking, Savings, CD, Money Market, etc.)
Name of Bank, S&L, or Credit Union	Address of Bank, S&L, or Credit Union	Acct Type, and Balance (Checking, Savings, CD, Money Market, etc.)
Name of Bank, S&L, or Credit Union	Address of Bank, S&L, or Credit Union	Acct Type, and Balance (Checking, Savings, CD, Money Market, etc.)

B. Stocks and Bonds
Company Name	Stock Held by	Market Value
Company Name	Stock Held by	Market Value
Company Name	Stock Held by	Market Value

C. Other Assets

Life Insurance net cash value:

Life Insurance face amount :

Vested interest in retirement fund :

Net worth of business(es) owned :

Total Value of Personal Belongings
(everything you own from silverware to clothes, etc.):

Total:

Automobiles owned :
Make & Year	Estimated Market Value	Loan Held By	Monthly Payment	Balance

Make & Year	Estimated Market Value	Loan Held By	Monthly Payment	Balance

Make & Year	Estimated Market Value	Loan Held By	Monthly Payment	Balance

Boats, etc. owned :
Make & Year	Estimated Market Value	Loan Held By	Monthly Payment	Balance

Make & Year	Estimated Market Value	Loan Held By	Monthly Payment	Balance

Make & Year	Estimated Market Value	Loan Held By	Monthly Payment	Balance

Make & Year	Estimated Market Value	Loan Held By	Monthly Payment	Balance

Make & Year	Estimated Market Value	Loan Held By	Monthly Payment	Balance

Liabilities Liability Types are Credit Cards, Mortgages, Personal or Private Loans, etc. We will not ask for account numbers. If the Lender requests them, we will contact you.
Name of Credit CompanyLiability Type:
Monthly Payment:	Months Left to Pay:	Unpaid Balance:

If Liability is Mortgage, provide property address below :, Address of Credit Company,

Name of Credit CompanyLiability Type:
Monthly Payment:	Months Left to Pay:	Unpaid Balance:

If Liability is Mortgage, provide property address below :, Address of Credit Company,

Name of Credit CompanyLiability Type:
Monthly Payment:	Months Left to Pay:	Unpaid Balance:

If Liability is Mortgage, provide property address below :, Address of Credit Company,

Other Liabilities

Alimony/Child Support/Separate Maintenance Payments owed to :

Job Related Expense (Child care, union dues, etc.) :

Property Information

Last Name :

If you have picked out a property to buy, fill this out if you can. If you have not picked out a property - go on to next section.

Purchase Price or Property Value

Loan Amount:

Subject Property Address:

City, State & Zip:

Year Built:

No. of Units:

Purpose of Loan: (Check All that apply) Purchase Refinance Construction Construction-Permanent Other

Declarations
Item	Borrower	Co-Borrower
a. Are there any outstanding judgments against you?	Y or N	Y or N
b. Have you been declared bankrupt within the last 7 years?	Y or N	Y or N
c. Have you had property foreclosed upon in the last 7 years?	Y or N	Y or N
d. Are you a party to a lawsuit?	Y or N	Y or 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 or N	Y or 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 or N	Y or N
g. Are you obligated to pay alimony child support or separate maintenance?	Y or N	Y or N
h. Is any part of the down payment borrowed?	Y or N	Y or N
i. Are you the co-maker or endorser on a note?	Y or N	Y or N
j. Are you a U.S. citizen?	Y or N	Y or N
k. Are you a permanent resident alien?	Y or N	Y or N
l. Do you intend to occupy the property as your primary residence?	Y or N	Y or N
Property Will be: (Check All that apply)Primary Residence Secondary Residence Investment Non-Owner Occupied Investment Owner Occupied Commercial

m. Have you had an ownership interest in a property in the last 3 years?

Y or N

If the answer to the question m above is YES, please check off the best fit from the following:
What type of Property did you own ?	How did you hold title to the home ?
Principal Residence Second Home Investment Property Leave Blank Not Applicable	Solely by yourself Jointly with your spouse Jointly with other person Leave Blank Not Applicable


I/We certify that the information provided in this application is true and correct as of the date set forth opposite my/our signature(s) 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 nor limited to, fine, 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 have made on this application.

We will need you to mail or bring by 2300 Biehn Street, Klamath Falls, OR 97601 - Your last two months pay stubs for each borrower, last two years W-2's, 1099's or Tax Returns & 3 months Bank Statements. We can not proceed to the next step without this information - It is required by all Lenders. We can not process your loan application till we have this documentation. Borrower Digital Signature: Date: Co-Borrower Digital Signature: Date:
* Denotes required field. You must provide the information requested.
Congratulations!! You are now done with this application - Please click the submit button below. We recommend that you print this page for your records as well. If you have any questions, comments or concern please feel free to state them here. If you have special needs, special requests, times to contact you, preference of contact (email only or phone after 8pm)- please list them here as well. I would like to thank you for taking the time to fill out this important application. I commend you for your patience and your time commitment as well. I sincerely look forward to aiding you with your mortgage needs and hope to talk to you soon. Questions/Comments: Thank You, Teresa N. Snyder By Referral Only® Real Estate & Mortgage Consultant....For Life! You may want to print this page for your records.