NMLS 148027 | MB-0903024

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Mesa Mortgage thanks you for working with Deb.
“We Make it Simple, We Make it Easy”

NMLS# 148027 / MB-0903024 / NMLS# 124952 / AZ License# LO-0929445

Loan App

Step 1 of 6

16%

Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Cell Phone
Email

Social Security #
Date of Birth
Marital Status
- Married (includes registered domestic partners)
- Unmarried (includes single, divorced, widowed)
- Separated
Number of Dependents
List Dependents Ages if Applicable
Employer Name
Employer Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Business Phone
Position / Title / Type of Business
Years on this Job
Monthly Income
Monthly Rent / Mortgage Payment

Bank Name
Bank Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Account Number
Balance

Automobiles Owned - Make & Year
Other Properties Owned
Other Property Market Value
Other Property Mortgage Payment

Are there any outstanding judgments 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 leu thereof in the last 7 years?
- Yes
- No
Are you 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 judgement?
- Yes
- No
(This would include such loans as home mortgage loans, SBA loans, home improvement loans, educational loans, manufactured home loans, any mortgage, financial obligation, bond or loan guarantee.)
Are you presently delinquent or in default of any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee?
- Yes
- No
Are you obligated to pay alimony, child support, or separate maintenance?
- Yes
- No
Is any part of the down payment borrowed?
- Yes
- No
Are you a co-maker or endorser on a note?
- Yes
- No
Are you a US Citizen?
- Yes
- No
Are you a permanent resident alien?
- Yes
- No
Do you intend to occupy the property as your primary residence?
- Yes
- No
If yes, complete the questions below.
Have you had an ownership interest in a property in the last three years?
- Yes
- No
What type of property did you own?
- Principal Residence
- Second Home
- Investment Property
How did you hold the title to the home?
- Solely by your self
- Jointly with your spouse
- Jointly with another person

Borrower Ethnicity
- I do not wish to furnish this information
- Hispanic or Latino
- Not Hispanic or Latino
Borrower Race
- American Indian or Alaska Native
- Asian
- Black or African American
- Native Hawaiian or Other Pacific Islander
- White

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