Mortgage Application PremierBank

Mortgage Loan Application

PremierBank is based in Fort Atkinson, Wisconsin and has physical locations in Jefferson, Rock, and Walworth Counties focusing on lending to people in the south central Wisconsin area.

Mortgage Loan Application

($) Loan Amount

($) Purchase Price (if applicable)

Term

Which loan officer are you currently working with?(Required)

Purpose of the Loan

Purchase

Refinance

Purchase Vacant Land

Construction

Home Equity Loan (Not Line of Credit)

Will this application be completed individually or jointly?

Individually

Jointly

Property Information

Is this a pre-qualification?

Yes

If this is a pre-qualification request, please select “Yes” and go directly to the Borrower Information section. If your request is not a pre-qualification, please select “No” and complete the Property Information below.

Property Address

Street Address City State / Province / Region ZIP / Postal Code

Property's Estimated Value

Number of Units

Is this a refinance transaction?

Yes

If this is a refinance transaction, please complete the following

Year Acquired

($) Original Cost

($) Amount of Existing Liens

Purpose of Refinance

Improvements

Made since purchase or

To be made with loan proceeds

Describe Improvements

APPLICANT(S) Check one of the following boxes. You may apply for separate credit in your name only, joint credit in your and the name of your spouse, or joint credit in your name and the name(s) of other joint applicant(s). Note: Separate credit and joint credit may also be marital purpose debt under Wisconsin Law.

Select One:(Required)

Separate Credit. Complete your personal information. Complete the co-applicants information about your spouse only if you are married and a Wisconsin resident.

Joint Credit with spouse as joint applicant. Complete your personal information and the co-applicant information.

Joint Credit with (name below) as joint applicant who is not your spouse. Each joint applicant must complete a separate application as if applying for separate credit.

Borrower Information

Name of Borrower #1

Date of Birth
MM slash DD slash YYYY

Social Security Number

Driver's License Number

Home Phone

Cell Phone

Email Address

Select Marital Status

Address
Street Address City State / Province / Region ZIP / Postal Code

Have you lived here for less than two years?

Yes

No

Years at this Address

Do you rent or own?

Rent

Own

Address
Street Address City State / Province / Region ZIP / Postal Code

Is your mailing address different than your home address?

Yes

No

Address
Street Address City State / Province / Region ZIP / Postal Code

Borrower Dependents

Number of Dependents

Ages of Dependents

Borrower Employment

Employer or Business Name

Years in this line of work or profession

Position or Title

Employer Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Employer Phone

Have you worked here for less than two years?

Yes

No

Select Years on the Job

Previous Employer

Position

Income

Start Date
Month
Day
Year

End Date
Month
Day
Year

Borrower Financial Information

Please note: 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. Also self employed borrowers may be required to provide additional documentation such as tax returns and financial statements. (before taxes)

Borrower Gross Monthly Income (Assets)

Gross Monthly Income (Assets)

($) Borrower Income

($) Other Income (if any)

Other Income Type

Borrower Current Monthly Housing Expenses

($) Rent

($) First Mortgage

($) Second Mortgage

($) Hazard Insurance

($) Property Taxes

($) Hazard Insurance

($) Property Taxes

($) Mortgage Insurance

($) HOA Dues

Borrower - List Checking & Savings Account Information Below

Bank Name

Account Number

($) Account value

Account Type

Borrower - Account #2

Bank Name

Account Number

($) Account value

Account Type

Borrower Account #3

Bank Name

Account Number

($) Account value

Borrower Real Estate Owned

Property Address
Street Address City State / Province / Region ZIP / Postal Code

($) Estimated Value

Borrower Additional Assets

Stocks & Bonds Description

($) Value

($) Life Insurance Face Amount

($) Cash Value

($) Vested interest in retirement plan

($) Net worth of business owned

Borrower Automobiles

Car #1 Make

Year

(S) Value

Car #2 Make

Year

(S) Value

Borrower Other Assets

Other Asset

($) Value

Other Asset

($) Value

Borrower Current Monthly Payments: (Liabilities)

Name of Company

($) Payment

Name of Company

($) Payment

Name of Company

($) Payment

Name of Company

($) Payment

Name of Company

($) Payment

Name of Company

($) Payment

Name of Company

($) Payment

Co-Borrower Information

Name of Co-Borrower

Date of Birth
MM slash DD slash YYYY

Social Security Number

Driver's License Number

Home Phone

Cell Phone

Email Address

Select Marital Status

Address
Street Address City State / Province / Region ZIP / Postal Code

Have you lived here for less than two years?

Yes

No

Years at this Address

Do you rent or own?

Rent

Own

Address
Street Address City State / Province / Region ZIP / Postal Code

Co-Borrower Dependents

Number of Dependents

Ages of Dependents

Co-Borrower Employment

Employer or Business Name

Years in this line of work or profession

Position or Title

Employer Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Employer Phone

Have you worked here for less than two years?

Yes

No

Select Years on the Job

Previous Employer

Position

Income

Start Date
Month
Day
Year

End Date
Month
Day
Year

Co-Borrower Financial Information

Co-Borrower Gross Monthly Income (Assets)

($) Co-Borrower Income

($) Other Income (if any)

Other Income Type

Co-Borrower Current Monthly Housing Expenses

($) Rent

($) First Mortgage

($) Second Mortgage

($) Hazard Insurance

($) Property Taxes

($) Hazard Insurance

($) Property Taxes

($) Mortgage Insurance

($) HOA Dues

Co-Borrower - List Checking & Savings Account Information Below

Bank Name

Account Number

($) Account value

Account Type

Borrower - Account #2

Bank Name

Account Number

($) Account value

Account Type

Co-Borrower Account #3

Bank Name

Account Number

($) Account value

Account Type

Co-Borrower Real Estate Owned

Property Address
Street Address City State / Province / Region ZIP / Postal Code

($) Estimated Value

Co-Borrower Additional Assets

Stocks & Bonds Description

($) Value

($) Life Insurance Face Amount

($) Cash Value

($) Vested interest in retirement plan

($) Net worth of business owned

Co-Borrower Automobiles

Car #1 Make

Year

(S) Value

Car #2 Make

Year

(S) Value

Co-Borrower Other Assets

Other Asset

($) Value

Other Asset

($) Value

Co-Borrower Current Monthly Payments: (Liabilities)

Name of Company

($) Payment

Name of Company

($) Payment

Name of Company

($) Payment

Name of Company

($) Payment

Name of Company

($) Payment

Name of Company

($) Payment

Name of Company

($) Payment

Declarations

Borrower - A. Will you occupy the property as your primary residence?

Yes

No

Co-Borrower - A. Will you occupy the property as your primary residence?

Yes

No

A (1). What type of property did you own?

A (2). How did you hold title to the property?

Borrower - B. If this is a Purchase Transaction: Do you have a family relationship or business affiliation with the seller of the property?

Yes

No

Co-Borrower - B. If this is a Purchase Transaction: Do you have a family relationship or business affiliation with the seller of the property?

Yes

No

Borrower - C. Are you borrowing any money for this real estate transaction (e.g. money for your closing costs or down payment) or obtaining any money from another party, such as the seller or realtor, that you have not disclosed on this loan application?

Yes

No

Co-Borrower - C. Are you borrowing any money for this real estate transaction (e.g. money for your closing costs or down payment) or obtaining any money from another party, such as the seller or realtor, that you have not disclosed on this loan application?

Yes

No

C (1). What is the amount of this money?

Borrower - D (1). Have you or will you be applying for a mortgage loan on another property (not the property securing this loan) on or before closing this transaction that is not disclosed on the loan application?

Yes

No

Co-Borrower - D (1). Have you or will you be applying for a mortgage loan on another property (not the property securing this loan) on or before closing this transaction that is not disclosed on the loan application?

Yes

No

Borrower - D (2). Have you or will you be applying for any new credit (e.g. installment loan, credit card, etc.) on or before closing this loan that is not disclosed on this application?

Yes

No

Co-Borrower - D (2). Have you or will you be applying for any new credit (e.g. installment loan, credit card, etc.) on or before closing this loan that is not disclosed on this application?

Yes

No

Borrower - E. Will this property be subject to a lien that could take priority over the first mortgage lien, such as a clean energy lien paid through your property taxes (e.g. the Property Assessed Clean Energy Program)?

Yes

No

Co-Borrower - E. Will this property be subject to a lien that could take priority over the first mortgage lien, such as a clean energy lien paid through your property taxes (e.g. the Property Assessed Clean Energy Program)?

Yes

No

Borrower - F. Are you a co-signer or guarantor on any debt or loan that is not disclosed on this application?

Yes

No

Co-Borrower - F. Are you a co-signer or guarantor on any debt or loan that is not disclosed on this application?

Yes

No

Borrower - G. Are there any outstanding judgements against you?

Yes

No

Co-Borrower - G. Are there any outstanding judgements against you?

Yes

No

Borrower - H. Are you currently delinquent or in default on a Federal debt?

Yes

No

Co-Borrower - H. Are you currently delinquent or in default on a Federal debt?

Yes

No

Borrower - I. Are you a party to a lawsuit in which you potentially have any personal financial liability?

Yes

No

Co-Borrower - I. Are you a party to a lawsuit in which you potentially have any personal financial liability?

Yes

No

Borrower - J. Have you conveyed title to any property in lieu of foreclosure in the past 7 years?

Yes

No

Co-Borrower - J. Have you conveyed title to any property in lieu of foreclosure in the past 7 years?

Yes

No

Borrower - K. Within the past 7 years, have you completed a pre-foreclosure sale or short sale, whereby the property was sold to a third party and the Lender agreed to accept less than the outstanding mortgage balance due?

Yes

No

Co-Borrower - K. Within the past 7 years, have you completed a pre-foreclosure sale or short sale, whereby the property was sold to a third party and the Lender agreed to accept less than the outstanding mortgage balance due?

Yes

No

Borrower - L. Have you had a property foreclosed upon in the last 7 years?

Yes

No

Co-Borrower - L. Have you had a property foreclosed upon in the last 7 years?

Yes

No

Borrower - M. Have you declared bankruptcy within the past 7 years?

Yes

No

Co-Borrower - M. Have you declared bankruptcy within the past 7 years?

Yes

No

Identify type(s) of bankruptcy:
Chapter 7
Chapter 11
Chapter 12
Chapter 13

(1) What type of property did you own?

(2) How did you hold title to the home?

Please let us know any comments and the best method of contacting you.

Demographic Information Borrower (s)

The purpose of collecting this information is to help ensure that all the 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.

Borrower

Borrower - Ethnicity: Check one or more
Hispanic or Latino
Mexican
Puerto Rican
Cuban
Other Hispanic or Latino
Not Hispanic or Latino
I do not wish to provide this information

Borrower - Other Hispanic or Latino - Print origin:

Borrower - Race: Check one or more
American Indian or Alaska Native
Asian
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Other Asian
Black or African American
Native Hawaiian or Other Pacific Islander
Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islander
White
I do not wish to provide this information

Borrower - Print name of enrolled or principal tribe

Borrower - Other Asian - Print Race:

Borrower - Other Pacific Islander - Print race:

Borrower - Sex

Female

Male

I do not wish to provide this information

Co-Borrower

Co-Borrower - Ethnicity: Check one or more
Hispanic or Latino
Mexican
Puerto Rican
Cuban
Other Hispanic or Latino
Not Hispanic or Latino
I do not wish to provide this information

Co-Borrower - Other Hispanic or Latino - Print origin:

Co-Borrower - Race: Check one or more
American Indian or Alaska Native
Asian
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Other Asian
Black or African American
Native Hawaiian or Other Pacific Islander
Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islander
White
I do not wish to provide this information

Co-Borrower - Print name of enrolled or principal tribe

Co-Borrower - Other Asian - Print Race:

Co-Borrower - Other Pacific Islander - Print race:

Co-Borrower - Sex

Female

Male

I do not wish to provide this information

Important Information About Procedures for Opening a New Account

To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents. You will be required to come into one of our locations to complete the loan process. (Sign loan papers, verify information, etc.)

Notice: We may report information about your account to credit bureaus. Late payments, missed payments, or other defaults on your account may be reflected in your credit report.
For the purpose of obtaining the credit described above, and any future credit granted to the undersigned by the creditor named above, the undersigned, jointly and severally, (1) represent that the above statements are true and complete, (2) authorize the creditor named above, or its agents, to verify them and obtain additional information concerning our credit, employment history or any other information including credit reports (although the creditor may rely on these statements without any further verificaation), to furnish, to the extent not prohibited by applicable law, credit experience with me to others, and to answer my questions about our credit experience and other financial relationships with the creditor, and (3) agree to the provisions of any rules, regulations or agreements of the creditor governing such credit. This application is creditor's property.
The creditor may share information bearing on my credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics or mode of living with its affiliates unless (1) I direct the creditor at the address above that such information is unrelated to my transactions or experiences with the creditor and may not be shred by the creditor with its affiliates, (2) the information constitutes "medical information" as defined under applicable federal law, or (3) the information when provided to an affiliate would constitute a "consumer report" under applicable federal law.

The undersigned understand that it may be a crime punishable by fine or imprisonment or both to knowingly make any false statements concerning any of the above facts.

Privacy Policy Information(Required)

I agree to accept PremierBank's Notice of Privacy Policy electronically.

I would like to receive PremierBank's Notice of Privacy Policy by mail.
You must choose one of the following options

Banking Sign In

Mortgage Loan Application

Mortgage Loan Application

Property Information

If this is a refinance transaction, please complete the following

Borrower Information

Borrower Dependents

Borrower Employment

Borrower Financial Information

Borrower Gross Monthly Income (Assets)

Gross Monthly Income (Assets)

Borrower Current Monthly Housing Expenses

Borrower - List Checking & Savings Account Information Below

Borrower - Account #2

Borrower Account #3

Borrower Real Estate Owned

Borrower Additional Assets

Borrower Automobiles

Borrower Other Assets

Borrower Current Monthly Payments: (Liabilities)

Co-Borrower Information

Co-Borrower Dependents

Co-Borrower Employment

Co-Borrower Financial Information

Co-Borrower Gross Monthly Income (Assets)

Co-Borrower Current Monthly Housing Expenses

Co-Borrower - List Checking & Savings Account Information Below

Borrower - Account #2

Co-Borrower Account #3

Co-Borrower Real Estate Owned

Co-Borrower Additional Assets

Co-Borrower Automobiles

Co-Borrower Other Assets

Co-Borrower Current Monthly Payments: (Liabilities)

Declarations

Demographic Information Borrower (s)

Important Information About Procedures for Opening a New Account