Apply Online

Instructions

Use this form to request mortgage information.
Please fill out as much of this form as possible.
When finished click on the send button.

Someone from NSB Mortgage will contact you. A phone number is required.

General Information

	Borrower	Co-borrower (If different)
Full Name:
Address:
City, State, Zip
Home Phone:
Length at current residence:
Previous address if less than 2 years
City, State, Zip
Work Phone:
Best time to contact:
E-mail:
Social Security #:
Employers:
Employer(s) Address
Employer(s) City
Employer(s) State
Employer(s) Zip
Employers' Phone Number:
Are you self employed ?	Yes No	Yes No
Length of Employment:
Current Job Title:
Gross Monthly Income:
Date of Birth:
My credit history is:	excellent good, but some lates some credit problems major credit problems don't know	excellent good, but some lates some credit problems major credit problems don't know

Bank Information - Bank 1

Name of Bank:

Average Balance:

Account Number:

Type of Account

Bank Information - Bank 2

Name of Bank:

Average Balance:

Account Number:

Type of Account

Bank Information - Bank 3

Name of Bank:

Average Balance:

Account Number:

Type of Account

Loan Request

Amount Requested:

Type of loan:

Property Information

*This information needs to be filled out for the property that is collateral for the loan

Street Address:

City, State, Zip Code:

Estimated Present Value:

Year Purchased:

Original Price:

Type of Property: Primary Second/Vacation Investment

Purchase Amount:

Loan Information

Mortgage Balances
Amount:

Held by:

Payment:

First:

Second:

Other:

Creditors

Name Amount Owed Monthly Payment
Will be paid off?

$ $ Yes No

$ $ Yes No

$ $ Yes No

$ $ Yes No

Other monthly debts and information - please describe

By submitting this on-line application, I/we authorize NSB Mortgage to check such things as my/our credit, business and employment status and histories.

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