MortgageNet@Work -- Get the right mortgage at the lowest price.

<%@ Language=VBScript %> MortgageNet@Work -- Get the right mortgage at the lowest price.

MortgageNet@Work specializing in debt consolidation and home improvement loans, educating the consumer with simple, straightforward facts.

Property Information and Purpose of Loan (Items marked with " * " are required for submission.)

Subject Property Address: (street, city, state, ZIP):

Purpose of Loan:*

If purpose of loan is other, please explain below:

Street Address:*

City:*

State:*

Zip Code:*

Loan Amount Desired:*

Estimated Value of Home:

		Property will be:*
Year Acquired	(example: 1999)	Primary Residence
Original Cost		Secondary Residence
Amount Existing Liens		Investment

Source of Down Payment, Settlement Charges and/or Subordinate Financing (explain)

Borrower/Co-borrower Information

I. Borrower's Name: (include Jr. or Sr. if applicable)

First Name:*	Middle Name:	Last Name:*

Email Address:	Social Security #*	- -
Email Address:	Home Phone* (incl. area code)	( ) -

Present Address (street, city, state ZIP):	Own * Rent*	Number of Years*
Street:*
City:*	State:* (Abvr.)	Zip Code:*


If residing at present address for less than two years, complete the following:
Former Address (street, city, state, ZIP):	Own Rent	Number of Years
Street:
City:	State: (Abvr.)	Zip Code:

II. Co-borrower's name: (include Jr. or Sr. if applicable) Do you have a CoBorrower

First Name:	Middle Name:	Last Name:

Email Address:	Social Security #	- -
Email Address:	Home Phone (incl. area code)	( ) -

Present Address (street, city, state, ZIP):	Own Rent	Number of Years
Street:
City:	State: (Abvr.)	Zip Code:

If residing at present address for less than two years, complete the following:

Former Address (street, city, state, ZIP):	Own Rent	Number of Years
Street:
City:	State: (Abvr.)	Zip Code:

Employment Information

I. Borrower

Name & Address of Present Employer
Employer Name:*
Street:*
City:*	State:* (Abvr.)	Zip Code:*

Position/Title/Type of Business
Years on this job:*	(If less than two years please complete Previous Employer Information)
Position*
Title*
Type of Business*
Business Phone (include area code):*	( ) -

Name & Address of Previous Employer
Employer Name:
Street:
City:	State: (Abvr.)	Zip Code:

Position/Title/Type of Business
Years on this job:
Position
Title
Type of Business
Business Phone (include area code):	( ) -

II.Co-borrower

Name & Address of Present Employer
Employer Name:
Street:
City:	State: (Abvr.)	Zip Code:

Position/Title/Type of Business
Years on this job:	(If less than two years please complete Previous Employer Information)
Position
Title
Type of Business
Business Phone (include area code):	( ) -

Name & Address of Previous Employer
Employer Name:
Street:
City:	State: (Abvr.)	Zip Code:

Position/Title/Type of Business
Years on this job:
Position
Title
Type of Business
Business Phone (include area code):	( ) -

Monthly Income & Combined Housing Expense Information

Gross Monthly Income	Borrower	Co-Borrower
Base Empl. Income*
Overtime
Bonuses
Commissions
Net Rental Income
Combined Monthly Housing Expense -- PRESENT*

Declarations

If you answer "yes" to any questions a through e, please use scroll box below for explanation(s)	Borrower	Co-Borrower
a. Are there any outstanding judgments against you?*	Y N	Y N
b. Have you been declared bankrupt within the past 7 years?*	Y N	Y N
c. Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?*	Y N	Y N
d. Is any part of the down payment borrowed?*	Y N	Y N
e. Are you a co-maker or endorser on a note?*	Y N	Y N

1. Acknowledgment and Agreement* You are free to disagree or agree with the acknowledgments below, however, please understand that if select 'DISAGREE' that your application automatically cannot be processed or pre-approved.

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 ot 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 misrepresentation which I/we have made on this application.

I/We Agree I/We Disagree

2. Authorization to Release Information*

I/We authorize MORTGAGENET.WORK DBA CaliforniaLoanInfo.com to verify any and all information that is needed to complete the loan process. Such information includes, but is not limited to, employment history and income; bank, money market and similar account balances; credit history; and copies of income tax returns.

I/We Agree I/We Disagree

3. The Housing Financial Discrimination Act of 1977 Fair Lending Notice*

It is illegal to discriminate in the provisions of or in the availability of financial assistance because of the consideration of:

a. Trends, characteristics or conditions in the neighborhood or geographic area surrounding a housing accommodation, unless the financial institution can demonstrate in the particular case that such consideration is required to avoid an unsafe and unsound business practice; or

b. Race, color, religion, sex, marital status, national origin or ancestry.

It is illegal to consider the racial, ethnic, religious or national origin composition of a neighborhood or geographic area surrounding a housing accommodation or whether or not such composition is undergoing change, or is expected to undergo change, in appraising a housing accommodation or in determining whether or not, or under what terms and conditions, to provide financial assistance.

These provisions govern financial assistance for the purpose of the purchase, construction, rehabilitation or refinancing of one-to-four unit family residence occupied by the owner and for the purpose of the home improvement of any one-to-four unit family residence.

If you have any questions about your rights, or if you wish to file a complaint, contact the management of this financial institution or the agency noted below.

I/We Agree I/We Disagree

4. Equal Credit Opportunity Act*

The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant's income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The Federal Agency that administers compliance with this laws concerning this Mortgage Company is the Federal Trade Commission, Pennsylvania and 6th Street N. W., Washington. D. C. 20580

We are required to disclose to you that you need not disclose income from alimony, child support or separate maintenance payment if you choose not to do so.

Having made this disclosure to you we are permitted to inquire if any of the income shown on your application is derived from such a source and to consider the likelihood of consistent payment as we do with any income on which you are relying to qualify for the loan for which you are applying.

I/We Agree I/We Disagree

Additional Information

Would you like to receive your pre-approval notice via email?*
When would you like us to contact you:*		Explain When to Contact :
How did you hear about us?*
If you answered, 'G, H, or I' to the above question, please specify the first and last name of the contact person who referred you to MORTGAGENET@WORK in the box on the right to ensure that proper credit is given to the appropriate loan originator.

Borrower/Co-borrower Signatures

Borrower's Signature*
Type in Name

____________________________________________________

Date

Co-Borrower's Signature
Type in Name

____________________________________________________

Date