Long Form Application

You will find our Residential Loan Application below. Please complete and submit the form and we will return your inquiry as soon as possible.

Note: Fields marked with * are required

Your Loan Officer*
Before starting the application, please select your loan officer. If you're unsure, please select "Not Sure" option.

Borrower Details
Borrower Name*
First Middle Last Suffix
Email*
Phone Number*
Social Security Number
Date of Birth
Date Format: MM slash DD slash YYYY
Nationality or Status
Marital Status
Number Of Dependents
Please enter a number from 0 to 20.
Dependents & Their Ages
Dependent Age (Yrs.)

Use the + button to add more dependent ages.
Co-Borrower Details (Optional)
Co-Borrower Name
First Middle Last Suffix
Co-Borrower Email
Co-Borrower Phone Number
Co-Borrower Social Security Number
Co-Borrower Date of Birth
Date Format: MM slash DD slash YYYY
Nationality or Status
Marital Status

Borrower Employment Information
Name Of Employer
Employer Business Address
Street Address City State Zip Code
Years On The Job
Years Employed In This Line Of Work
Position/Title Or Business Type
Business Phone No.
Borrower Base Empl Income (current)
NOTE: Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.
Co-Borrower Employment Information
Name Of Co-Borrower Employer
Co-Borrower Employer Business Address
Street Address City State Zip Code
Years On The Job
Years Employed In This Line Of Work
Co-Borrower Position/Title Or Business Type
Co-Borrower Employer/Business Phone No.
Co-Borrower Base Empl Income (current)
NOTE: Self Employed Co-Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.

Schedule Of Real Estate Owned
Real Estate Owned
Property Address Type Of Property Present Market Value Amount Of Mortgages & Liens

Use the + button to add more properties.
Phone
This field is for validation purposes and should be left unchanged.

Get up-to-date details on mortgage rates & plans:

828 East Blvd, Suite 301
Charlotte, NC 28203
FAX: (980) 259-6669

Property Address	Type Of Property	Present Market Value	Amount Of Mortgages & Liens

Dependent Age (Yrs.)