ONLINE LOAN APPLICATION
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Select a Loan Officer:	Dave Streb Dennis Politte Don Simmons Mandii Kausch
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Applicant Information
Primary Borrower's Name (first and last):
Borrower Social Security #:
Borrower Date of Birth:
Borrower Employer:
Years at Current Employer:	Less than 1 year 1 year 2 years 3 years 4 years 5 years or more
Yearly Income:
Is There a Co-Borrower?	Yes No
Co-Borrower Name (first and last):
Co-Borrower Social Security #:
Co-Borrower Date of Birth:
Co-Borrower Employer:
Years at Current Employer:	Less than 1 year 1 2 years 3 years 4 years 5 years or more
Co-Borrower Yearly Income:
Current Street Address:
City, State, Zip Code
Home Phone:
Work Phone:
Best Time to Call:

Current Property Information
Type of House Currently Owned:	Single Family Multi-Family Other Rent
Current Value:
Purchase Price:
Mortgage Balance:
Interest Rate:
Fixed or Adjustable:	Fixed second
Monthly Payment:
Behind on Payments:	No Yes

Loan Information
Loan Type:	Purchase Refinance Home Equity Loan Other
Type of Loan You are Looking For:	15 year fixed 30 year fixed 1/1 ARM 2/1 ARM 3/1 ARM 5/1 ARM Interest Only Other (select up to 3)
Estimate Your Credit Profile:	Excellent Good Fair Poor