Homeland Financial New Purchase Application Form BORROWER INFORMATION SECTION BORROWER     CO-BORROWER Full Name: Date of Birth: Current Address: City, State, Zip Code: ,   ,   Do You Presently: Rent        Own Rent     Own Time at Current Address: Yrs     Months Yrs     Months Home Phone Number: Best Time to Call: AM  Afternoon  Evening AM  Afternoon  Evening Email Address: Are You Self Employed? Yes       No Yes       No If No - Name of Employer: City, State, Zip Code: ,   ,   Work Phone Number: Job Position / Title: Time On Job: Yrs     Months Yrs     Months Time in Line of Work: Yrs     Months Yrs     Months Gross Monthly Income: $ $ CREDIT SECTION My Credit History Is... Excellent! Good, but some lates Some credit problems Major credit problems --Select One-- Excellent! Good, but some lates Some credit problems Major credit problems --Select One-- No. of times you were 30 days late on installment, credit cards, rent or mortgage in last 12 mos. --Select-- 1-2 3-4 5 or more times None! --Select-- 1-2 3-4 5 or more times None! Any outstanding collections or judgments? No    Yes -- Amount $ No    Yes -- Amount $ Permission to pull Credit? Yes        No Yes        No LOAN REQUEST SECTION Type of Property: Primary Residence  Second Home  Investment Amount of Loan Desired: $ Type of Loan Desired:   Fixed Rate       Adjustable Rate (ARM) Term of Loan (in Years): 30    25    20     15    10    5 Address of Property: City, State, Zip Code: ,     Down Payment: $      OR      % Source of Down Payment: Additional Information or Comments: Please tell us how you heard about us: