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Home Purchase Loan Application

*Required Fields

1. Registration Information

User Name*		Password*
Email Address*		Confirm Password*

2. Contact Person

Do you have a First AFG Financial contact person?

Yes No

3. Personal Information

Borrower

Co-borrower
(if applicable)

First Name*

Middle Initial

Last Name*

Social Security Number*

- -

Date of Birth*
(mm/dd/yyyy)

/ /

Marital Status*

Email*

Current Address*

City*

State*

Zip*

Home Phone*

( ) -

Fax

( ) -

Rent or Own?*

How Long at Address

Years Months

Rent Amount($)

4. Employment Information

Employer Name*

Self Employed

Work Phone*

( ) -

Time on Job

Years Months

Monthly Gross Income ($)*

5. Combined Assets

Checking Balance($)

Savings Balance($)

Stocks & Bonds ($)

7. Subject Property Information

Address*

City*

State*

Zip*

Number of Units*

Year Built*

Property Type*

6. Loan Details

Loan Amount*

7. Declarations

		Borrower		Co-borrower
a.	Are there any outstanding judgments against you?		Yes		Yes
a.	Are there any outstanding judgments against you?		No		No
b.	Have you been declared bankrupt within the past 7 years?		Yes		Yes
b.	Have you been declared bankrupt within the past 7 years?		No		No
c.	Have you had property forclosed upon or given title or deed in lieu thereof in the last 7 years?		Yes		Yes
c.			No		No
d.	Are you a party to a lawsuit?		Yes		Yes
d.	Are you a party to a lawsuit?		No		No
e.	Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgement?		Yes		Yes
e.			No		No
f.	Are you presently delinquent or in default on any Federal debt or any other loan, mortgage financial obligation bond, or loan guarantee?		Yes		Yes
f.			No		No
g.	Are you obligated to pay alimony, child support, or separate maintenance?		Yes		Yes
g.			No		No
h.	Is any part of the down payment borrowed?		Yes		Yes
h.	Is any part of the down payment borrowed?		No		No
i.	Are you a co-maker or endorser on a note?		Yes		Yes
i.	Are you a co-maker or endorser on a note?		No		No
j.	Are you a U.S. citizen?		Yes		Yes
j.	Are you a U.S. citizen?		No		No
k.	Are you a permanent resident alien?		Yes		Yes
k.	Are you a permanent resident alien?		No		No
l.	Do you intend to occupy the property as your primary residence?		Yes		Yes
l.			No		No
m.	Have you had an ownership interest in a property in the last three years?		Yes		Yes
m.			No		No

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 reverification of any information contained in the 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 should change 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 successor or assign of the Lender without notice to me and/or the administration of the loan account 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(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 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 misrepresentaion which I/we have made on this application.

What type of property did you own? *

How did you hold title to the home? *

Borrower Agreement		Co-Borrower Agreement

Type Full Name*		Type Full Name

By entering the above information the applicants agree to all conditions stated above.