D. White's Online Loan Application

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D. White & Co., LLC - Loan Application
Personal Information
*Borrower`s 1st Name:
*Borrower`s Last Name:
*Social Security NumberUse ###-##-#### format
*Birth Date
Is there a co-borrower?Check only if Yes.
*Co-borrower`s 1st Name:
*Co-borrower`s last Name:
*Co-borrower`s Social Security Number:
Co-Borrower`s Birth Date
Contact Information
*Street Address
*City
State/Province:
*Zip Code:
*Do you own or rent?
Own
Rent
How long have you lived at this address?
Less than 2 years
More than 2 years
*Previous Street Address
*Previous City
*State/Province:Canadian provinces included
*Zip Code:
*E-Mail:Valid e-mail is required
*Preferred phone number
Purpose and Type of Loan
*Purpose of Loan
Purchase a property
Refinance to improve loan terms (rate, period, adjustments, payments)
Refinance to take cash out
Obtain a 2nd
*Type of Loan
Conventional FHA VA 2nd 
*Occupany Intent Statement
*Loan AmountEstimate if necessary
*Property Value or the Purchase AmountEstimate if necessary
Income and Asset Information
*Borrower`s Annual Income
Are you self-employed?
Yes No 
*Borrower`s Employer
*How long have you worked here?
Less than 2 years
More than 2 years
Previous employer
Co-Borrower`s Annual IncomeEstimate if necessary
Is Co-Borrower Self-Employed
Yes No 
Co-Borrower`s Employment
How long with this employer?
Less than 2 years
More than 2 years
Co-Borrower`s previous employer
Asset Information
*Amount of money in checking, savings, & non-retirement financial investments
Amount of money in retirement accounts
Source of Down-payment/Funds to close
Additional Useful or Required Information
Have you ever declared bankrupty?
Yes - within the last 7 years Yes - beyond 7 years ago No 
Are you...?
Married Unmarried Separated 
*Are you obligated to pay alimony/child support
Yes No 
How much per month?
Authorization
Each of the undersigned specifically represents to Lender and to Lenders actual or potential agents, brokers, processors, attorneys, insurers, servicers, successors and assigns and agrees and acknowledges that:

(1) the information provided in this application is true and correct as of the date set forth opposite my signature and that any intentional or negligent misrepresentation of this information contained in this application may result in civil liability, including monetary damages, to any person who may suffer any loss due to reliance upon any misrepresentation that I have made on this application, and/or in criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Sec. 1001, et seq.;

(2) the loan requested pursuant to this application (the `Loan`) will be secured by a mortgage or deed of trust on the property described in this application;

(3) the property will not be used for any illegal or prohibited purpose or use;

(4) all statements made in this application are made for the purpose of obtaining a residential mortgage loan;

(5) the property will be occupied as indicated in this application;

(6) the Lender, its servicers, successors or assigns may retain the original and/or an electronic record of this application, whether or not the Loan is approved;

(7) the Lender and its agents, brokers, insurers, servicers, successors, and assigns may continuously rely on the information contained in the application, and I am obligated to amend and/or supplement the information provided in this application if any of the material facts that I have represented herein should change prior to closing of the Loan;

(8) in the event that my payments on the Loan become delinquent, the Lender, its servicers, successors or assigns may, in addition to any other rights and remedies that it may have relating to such delinquency, report my name and account information to one or more consumer reporting agencies;

(9) ownership of the Loan and/or administration of the Loan account may be transferred with such notice as may be required by law;

(10) neither Lender nor its agents, brokers, insurers, servicers, successors or assigns has made any representation or warranty, express or implied, to me regarding the property or the condition or value of the property;

and (11) my transmission of this application as an `electronic record` containing my `electronic signature,` as those terms are defined in applicable federal and/or state laws (excluding audio and video recordings), or my facsimile transmission of this application containing a facsimile of my signature, shall be as effective, enforceable and valid as if a paper version of this application were delivered containing my original written signature.
Acknowledgement. Each of the undersigned hereby acknowledges that any owner of the Loan, its servicers, successors and assigns, may verify or reverify any information contained in this application or obtain any information or data relating to the Loan, for any legitimate business purpose through any source, including a source named in this application or a consumer reporting agency.
I/we consent to the above statements:
Yes
No
Authorization to Release Credit Information

I/we authorize D. White & Co. LLC to obtain my/our credit report for the purpose of evaluating this application and determining my/our mortgage account status and mortgage payoff information. This information that is obtained is strictly confidential.

We further, agree to pay for the credit report.
*I/We consent to having our credit checked
Yes
No
Credit/Debit Card Information
Your card information will be used to order a credit report. The charge on your bill will be to Factual Data. You will receive a copy of your report along with your credit score information.
Card Brand:
Card Number:No dashes or spaces please
3 Digit PINFrom the back of the card
Expiration Month:From your card
Expiration Year:From your card
Factors you wish us to consider?
Remaining Characters
1000 Character Limit
 

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NMLS: #320535
Colorado License: #LMB100010306
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