Your information  ( required)
Your name:	First	Last
Your phone number:	ext.
Best time to call:
Your e-mail address:
Marital status:	Select choice Married Single
Co-borrower name:
Your current address:
Address:
City:
State:	Zip:
I currently:	Select choice Own Rent
Employment and expenses
Your employment status:	Select choice Work for employer Self-employed Other or none
Co-borrower's employment status:	Select choice Work for employer Self-employed Other or none
Occupation:
How long have you been working for your present employer? (If self-employed, for how long?) months   What is your total monthly income? (including the income of anyone applying with you) dollars
Your current housing costs: (Please include the housing costs of anyone applying with you.)
Rent:	monthly
First mortgage:	monthly
Second mortgage:	monthly
Property Taxes:	monthly
Homeowner's insurance:	monthly
Please enter any additional debts such as a student loan, car payments, or credit card debt. (include the debts of anyone applying with you) dollars
Address of the property you are buying, if known:
Address:
City:
State:	Zip:
Property purpose:	Select choice New residence Rental Vacation Home
Please provide any additional information you think will be helpful:
LEGAL STUFF  I certify that the information provided here in this application is true and correct to the best of my knowledge. Further, I authorize Countryside Realty (countrysidenh.com) and their mortgage lender(s) to verify any information included with or made part of this application including other documents that may be requested at a later date. I also authorize any person or party named in this application to provide any and all information that Countryside Realty (countrysidenh.com) and their mortgage lender(s) may request including, but not limited to; employment, income history, credit records, pay histories, income tax returns, bank and/or other depository account balance history or any other information Countryside Realty (countrysidenh.com) and their mortgage lender(s) deems necessary to secure a credit decision. I further understand that an appraisal will be required on the property that I am financing and that the charge for this service is a pass-through expense that will be paid by me at the time requested. Typically, these fees range from $250 to $375 (or more) depending on the complexity of the appraisal and the required format in the underwriting process. Finally, I understand that if I elect to lock-in my rate now, that: 1. the rate, points and fees are subject to confirmation by the mortgage lender.  2 .the rate must be rates that are in effect at the time of receipt of completed application by the mortgage lender. Loans submitted after 4:00pm Pacific Time will be subject to the mortgage lender's pricing in effect the following business day.  3. I will receive confirmation within 24 hours of receipt of my request. If you do not receive confirmation within 24 hours, you must contact us no later than the next business day to ensure an interest rate lock-in.