Omni Home Financing

The following form provides the information needed to help us analyze your mortgage refinance options and recommend the best programs and lowest rates for you. Simply complete the form to the best of your ability and submit it. We normally will be in touch within 24 hours, excluding holidays. All information is private.

This form should take approximately five minutes to complete.

Loan Information

Loan Officer:
Loan Purpose:
Loan Term:
Loan Type:
Estimated Home Value :
Property Type:
Occupancy:

Is there a Co-Borrower on this application?

Yes No

Personal Information

	Primary Applicant	Co-Applicant
Salutation:
First Name:
Middle Initial:
Last Name:
Address:
Address 2:
City:
State:
Zip:
Own or Rent:
Monthly Rent:
Time in Residence:	Years: Months:	Years: Months:
Home Phone:
Work Phone:
Cell Phone:
Best Contact Method:
Email Address:
Social Security #:
Date of Birth:
Gross Monthly Income:
Other Income:
	Notice: Alimony, child support, or separate maintenance income need not be revealed if the borrower or co-borrower does not choose to have it considered for repaying this loan. If you would prefer a low doc program - enter "stated" for the income amount.
Education Level:
Employer:
Job Title:
Self Employed:	Yes No	Yes No
Time employed at current job:	Years: Months:	Years: Months:
Years employed in current line of work/profession:

Job History

	Primary Applicant	Co-Applicant
Previous Employer:
Previous Job Title:
Time at Previous Job:	Years: Months:	Years: Months:
Previous Employer 2:
Previous Job Title 2:
Time at Previous Job 2:	Years: Months:	Years: Months:

Previous Residency (please go back 2 years)

	Primary Applicant	Co-Applicant
Move In Date:	Years: Months:	Years: Months:
Move Out Date:	Years: Months:	Years: Months:
Address:
City:
State:
Move In Date:	Years: Months:	Years: Months:
Move Out Date:	Years: Months:	Years: Months:
Address:
City:
State:
Move In Date:	Years: Months:	Years: Months:
Move Out Date:	Years: Months:	Years: Months:
Address:
City:
State:

Refinance Property Information -

Street Address:
City:
State:
Zip Code:
Month/Year Purchased:
Purchase Price
Yearly Taxes:
Yearly Insurance:
Do you plan on Escrowing Taxes & Insurance?

Current Real Estate Owned

	Primary Applicant	Co-Applicant
Property Address :
Property City :
Property State :
Property Zip :
Property Value:
Existing Liens:	Yes No	Yes No

	Lender	Balance	Payment
First Mortgage:
Second Mortgage:
Equity Line:

Current Assets

Asset 1:	Type: Institution: Value:
Asset 2:	Type: Institution: Value:
Asset 3:	Type: Institution: Value:
Asset 4:	Type: Institution: Value:
Asset 5:	Type: Institution: Value:

HMDA & Equal Credit Opportunity Disclosures

Sex:

Male Female

Declarations

Additional Comments:

I authorize Omni Home Financing to obtain information regarding my credit, employment history, income and assets.
I authorize Omni Home Financing to obtain my credit report and information concerning any property that may secure my loan.

The following information is requested by the Federal Government for certain types of loans related to a dwelling, in order to monitor the lender's compliance with Equal Credit Opportunity, Fair Housing, and Home Mortgage Disclosure (HMDA) laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a lender may neither discriminate on the basis of this information, nor on whether you choose to furnish it. However, if you choose not to furnish it, under Federal regulations this Lender is required to note race and sex on the basis of visual observation or surname. If you do not wish to furnish the information, please check the box below. Lender must review the material to assure that the disclosure satisfies all requirements to which the Lender is subject under applicable state law for the particular type of loan applied for.
	Primary Applicant	Co-Applicant
Race/National Origin:	I do not wish to provide this information	I do not wish to provide this information
	American Indian or Alaskan Native	American Indian or Alaskan Native
	Black, not of Hispanic origin	Black, not of Hispanic origin
	Hispanic	Hispanic
	White, not of Hispanic Origin	White, not of Hispanic Origin
	Other:	Other:

	Primary Applicant	Co-Applicant
Are there any outstanding judgments against you?	Yes No	Yes No
Have you been declared bankrupt within the past 7 years?	Yes No	Yes No
Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?	Yes No	Yes No
Are you a party to a lawsuit?	Yes No	Yes No
Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment?	Yes No	Yes No
Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee?	Yes No	Yes No
Are you obligated to pay alimony, child support, or separate maintenance?	Yes No	Yes No
Are you a co-maker or endorser on a note?	Yes No	Yes No
Are you a U.S. citizen?	Yes No	Yes No
Are you a permanent resident alien?	Yes No	Yes No
Do you intend to occupy the property as your primary residence?	Yes No	Yes No
Have you had an ownership interest in a property in the last three years?	Yes No	Yes No
What type of property did you own?
How did you hold title?