Homeland Financial - Refinance Online 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 or credit cards 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 Term of Loan (in Years): 30    25    20     15    10    5 Address of Property: City, State, Zip Code: ,     Estimated Property Value: $ Additional Information or Comments: Please tell us how you heard about us: