* Required Information

Loan Information

Applicant Information

Current Employer

Sources of Other Income

Including social security, disability, pension, rental income, alimony, child support or separate maintenance. You do not have to reveal if you do not wish to have it considered as a bases for repaying this obligation.

Primary Mortgage Information

Marital Status

Complete only if: for joint or secured credit, or applicant resides in a community property state or is relying on property located in such a state as a basis for repayment of the credit requested.

Other Party Marital Status

Notice - Appraisal Copy:

Loan Secured by 1st Lien on a Dwelling: Centier Bank may order an appraisal to determine the property's value and charge you for this appraisal. We will promptly give you a copy of any appraisal, even if your loan does not close. You can pay for an additional appraisal for your own use at your own cost.

Notice of negative information:

We may report information about your account to credit bureaus. Late payments, missed payments or other defaults on your account may be reflected in your credit report.

Signatures:

I certify that everything I have stated in this application and on any attachments is correct. You may keep this application whether or not it is approved. By submitting below I authorize you to optain my credit bureau and employment history and to answer permissible questions, under the Fair Credit Reporting Act, others may ask you about my credit record with you. I understand that I must update credit information at your request if my financial condition changes.