Please fill in all the fields with asterisks.
Loan Application
Application Information
*
First Name
Middle Initial
*
Last Name
*
Email Address
*
Address 1
Address 2
*
City
*
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
*
Zip Code
*
Day Time Phone #
Ex. ### - ### - ####
*
Evening Time Phone #
Ex. ### - ### - ####
Loan Information
*
Desired Loan Amount
$
At Least 50000
*
Loan For
Purchase
or Refinance
*
Trust Deed
1st T.D.
or 2nd T.D.
If 2nd T.D.
1st T.D.
*
Annual Income
20K - 30K
40K - 50K
60K - 70K
80K - 90K
100K - 110K
120K - 130K
140K - 150K
160K - 170K
180K - 190K
200K - 210K
220K - 230K
240K - 250K
260K - 270K
280K - 290K
300K - 310K
320K - 330K
340K - 350K
360K - 370K
380K - 390K
400K - 410K
420K - 430K
440K - 450K
460K - 470K
480K - 490K
500K - 510K
520K - 530K
540K - 550K
560K - 570K
580K - 590K
600K - 610K
620K - 630K
640K - 650K
660K - 670K
680K - 690K
700K - 710K
720K - 730K
740K - 750K
760K - 770K
780K - 790K
800K+
*
Credit History
Excellent
Good
Fair
Poor
*
Filed For Bankruptcy?
No
Yes
If So, What Year?
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
Earlier
New Property Information
*
Type of Property
Single Family Residence
Apartment (1 - 4)
Apartment (5+)
Commercial
Industrial
Land
Other
If Other, Please Explain.
*
Estimate Purchase Price
$
At Least 50000
*
Approx. Property Value
$
At Least 50000
*
City
*
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
*
Zip Code
Y
N
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for a loan. This application is being used as a pre-qualification
only and is not an application for credit.
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© 2002 Emerald Financial