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Enter Your Current Address

Select Your Current State

Best Time To Call

Morning Afternoon Evening

Do you have the address of the property you wish to purchase?

Yes No

What type of residence is it?

Primary Residence . Investment Property Second Home/Vacation Home

Enter The Property Address

What are you trying to achieve?

New Purchase Home Refinance New Construction

What Loan Amount Are You Looking For?

How Much Will You Put In Down Payment?

Credit Check Authorization

Do you authorize us to pull you and your co-borrower’s credit reports in order to pre-qualify you for a loan? (If so, please provide social security numbers and date of births). Yes No

Borrowers Full Name

Borrower Date Of Birth

Borrower Marital Status

Married . Unmarried (single, divorced, widowed) Separated .

Borrowers Number Of Dependents

Borrowers Social Security Number

Will The Borrower's Spouse Apply For This Loan?

Yes No

Borrower's Spouse Full Name

Borrower's Spouse Date Of Birth

Borrower's Spouse Marital Status

Married . Unmarried (single, divorced, widowed) Separated .

Borrower's Spouse Number Of Dependents (Not Listed By Spouse)

Borrowers Social Security Number

Own Or Rent Current Address?

Own Rent

Years At Current Address

Have You Been At Current Address For Less Than 2 Years?

Yes No

Enter Your Previous Address

Own Or Rent Previous Address?

Own Rent

Are You Self Employed?

No Yes

Who Is Your Current Employer?

Your Job Position/Title

Do you have a secondary employer or have been employed in current position for less than 2 years?

Yes No

Secondary/Previous Employer

Your Job secondary/previous Position/Title

Income Information

*Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements. Notice: Alimony, child support, or separate maintenance income need not be revealed if the Borrower(B) or Co- Borrower(C) does not choose to have it considered for repaying this loan.

Do you have other types of income?

Yes No

Income Information

B/C Description of other income B/C Description of other income B/C Description of other income

Present Monthly Housing Expense Information

Are there any outstanding judgements against you?

Yes No

Have you been declared bankrupt within the past 7 years?

Yes No

Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?

Yes No

Are you a party to a lawsuit?

Yes No

Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment? (This would include such loans as home mortgage loans, SBA loans, home improvement loans, educational loans, manufactured (mobile) home loans, any mortgage, financial obligation, bond, or loan guarantee. If "Yes," provide details, including date, name and address of Lender, FHA or VA case number, if any, and reasons for the action)

Yes No

Are you presently delinquent or in default on any federal debt or any other loan, mortgage, financial obligation bond, or loan guarantee? If "Yes," give details as described in the preceding question.

Yes No

Are you obligated to pay alimony, child support, or separate maintenance?

Yes No

Is, or will, any part of the down payment be borrowed?

Yes No

Are you a co-maker or endorser on a note?

Yes No

Are you a U. S. citizen?

Yes No

Are you a permanent resident alien?

Yes No

Do you intend to occupy the property as your primary residence?

Yes No

Have you had an ownership interest in a property in the last three years?

Yes No

What type of property did you own?

How is the title held on your previous property?

ACKNOWLEDGMENT AND AGREEMENT

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.

Government Monitoring

The purpose of collecting this information is to help ensure that all applicants are treated fairly and that the housing needs of communities and neighborhoods are being fulfilled. For residential mortgage lending, Federal law requires that we ask applicants for their demographic information (ethnicity, sex, and race) in order to monitor our compliance with equal credit opportunity, fair housing, and home mortgage disclosure laws. You are not required to provide this information, but are encouraged to do so. You may select one or more designations for "Ethnicity" and one or more designations for "Race". The Law provides that we may not discriminate on the basis of this information, or on whether you choose to provide it. However, if you choose not to provide the information and you have made this application in person, Federal regulations require us to note your ethnicity, sex, and race on the basis of visual observation or surname. The law also provides that we may not discriminate on the basis of age or marital status information you provide in this application. If you do not wish to provide some or all of this information, please check below.

Ethnicity?

Hispanic or Latino Not Hispanic or Latino

Sex?

Female Male

By clicking the "Submit Now!" button and submitting your information, you agree to receive emails, phone calls, and/or text messages from Security America Mortgage at the number provided. This will help expedite your Loan Process.

Enter Your Current Address

Select Your Current State

Best Time To Call

Do you have the address of the property you wish to purchase?

What type of residence is it?

Enter The Property Address

What are you trying to achieve?

What Loan Term Are You Looking For?

What Loan Amount Are You Looking For?

How Much Will You Put In Down Payment?

Credit Check Authorization

Borrowers Full Name

Borrower Date Of Birth

Borrower Marital Status

Borrowers Number Of Dependents

Borrowers Social Security Number

Will The Borrower's Spouse Apply For This Loan?

Borrower's Spouse Full Name

Borrower's Spouse Date Of Birth

Borrower's Spouse Marital Status

Borrower's Spouse Number Of Dependents (Not Listed By Spouse)

Borrowers Social Security Number

Own Or Rent Current Address?

Years At Current Address

Have You Been At Current Address For Less Than 2 Years?

Enter Your Previous Address

Own Or Rent Previous Address?

Are You Self Employed?

Who Is Your Current Employer?

Your Job Position/Title

Do you have a secondary employer or have been employed in current position for less than 2 years?

Secondary/Previous Employer

Your Job secondary/previous Position/Title

Income Information

Do you have other types of income?

Income Information

Present Monthly Housing Expense Information

Are there any outstanding judgements against you?

Have you been declared bankrupt within the past 7 years?

Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?

Are you a party to a lawsuit?

Are you presently delinquent or in default on any federal debt or any other loan, mortgage, financial obligation bond, or loan guarantee? If "Yes," give details as described in the preceding question.

Are you obligated to pay alimony, child support, or separate maintenance?

Is, or will, any part of the down payment be borrowed?

Are you a co-maker or endorser on a note?

Are you a U. S. citizen?

Are you a permanent resident alien?

Do you intend to occupy the property as your primary residence?

Have you had an ownership interest in a property in the last three years?

What type of property did you own?

How is the title held on your previous property?

ACKNOWLEDGMENT AND AGREEMENT

Government Monitoring

Ethnicity?

Race?

Sex?