Secure Mortgage Information Sheet
2540 Olentangy River Road, Columbus, OH 43202
Phone: (614) 447-3675 • Fax: (614) 447-3824
1155 16th Street, NW, Washington, DC, 20036
Phone: (202) 452-8915 • Fax: (202) 776-8221

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Please complete all information. When finished, please send your application to ACSFCU by pressing the Submit button at the bottom of the form. All our forms are encrypted for your security.

 
Mortgage Information
Will there be a co-applicant on this application? Yes No
Purchase
Loan Amount:
Purchase Price:
Expected Down Payment:
Refinance
Estimated Value:
Existing 1st Mortgage Balance:
Existing 2nd Mortgage Balance:
Annual Property Taxes:
Annual Homeowner's Insurance:
Mortgage Questions
Do you prefer to have your property taxes and homeowners insurance included in your monthly payment?
Yes No
Do you own any other real estate? Yes No
     If yes, do you plan to: Sell it Rent it Use as vacation home
 
Primary Applicant
Personal Information
Name:
First: Middle: Last: Suffix:
Social Security Number:

555-55-5555
Date of birth:

mm/dd/yyyy
Marital Status: Married Unmarried (includes single, widow, & divorced)
What is your e-mail address?
(Re-enter your e-mail address)
 
I Don't Have An Email Address
Home Phone Number:
555-555-5555
Cell Phone Number:
555-555-5555
What is your home address?
Street: City: State: Zip:
Rent/Own/Buying:
Payment Amount:
Time at residence:
Previous address (if less than 2 years at current residence):
Street: City: State: Zip:
Employment Information
Work phone number:
ext.
555-555-5555
Current employer:
Employment Address:
Street: City: State: Zip:
Title or position:
 
Joint or Other Applicant
If your loan application is for joint credit, for individual credit relying on income or assets from other sources, or you are married and reside in a community property state, you must also fill out this section of the application. If you are applying for individual credit, you can skip this section.
Personal Information
Name:
First: Middle: Last: Suffix:
Social Security Number:

555-55-5555
6.4 - Date of birth:

mm/dd/yy
Marital Status: Married Unmarried (includes single, widow, & divorced)
Home Phone Number:
555-555-5555
Cell Phone Number:
555-555-5555
What is your home address?
Street: City: State: Zip:
Rent/Own/Buying:
Payment Amount:
Time at residence:
Previous address (if less than 3 years at current residence):
Street: City: State: Zip:
Employment Information
Work phone number:
ext.
555-555-5555
Current employer:
Employment Address:
Street: City: State: Zip:
Title or position:
Salary: $ .00 Monthly
How long employed:
Note: Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Source of other income:
Salary: $ .00 Monthly
 
Income & Asset Information
Gross monthly pay: $ .00
Note: Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Other Income: $ .00
Savings/Checking balance:
Real Estate: Locations: Value:
Auto: Year: Make: Model:
Other Asset:
Other Asset:
 
Debt Information
Lender
Balance
Monthly Payment
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
$ .00
 
Property Information
Property address?
Street: City: State: Zip:
Annual Property Taxes:
Annual condo/PUD fees:
Annual Hazard Insurance:
 
Declarations
If you answer "Yes" to any questions 1 through 13, please use the comments box for explanation.

Borrower
Co-Borrower
  1. Are there any outstanding judgments against you?
Yes No
Yes No
  2. Have you been declared bankrupt within the past 7 years?
Yes No
Yes No
  3. Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?
Yes No
Yes No
  4. Are you a party to a lawsuit?
Yes No
Yes No
  5. Have you ever directly or indirectly been obligated on any loan which resulted in foreclosure, transfer to title in lieu of foreclosure, or judgment? (This would include such loans as home mortgage loans, SBA loans, home improvement loans, educational loans, manufactured (mobile) home loans, any mortgage, financial obligation, bond, or loan guarantee. If "Yes," provide details, including date, name, and address of Lender, FHA or VA case number, if any, and reasons for the action.)
Yes No
Yes No
  6. Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee? If "Yes," give details as described in the preceding question.
Yes No
Yes No
  7. Are you obligated to pay alimony, child support, or separate maintenance?
Yes No
Yes No
  8. Is any part of the down payment borrowed?
Yes No
Yes No
  9. Are you a co-maker or endorser on a note?
Yes No
Yes No
10. Are you a US citizen?
Yes No
Yes No
11. Are you a permanent resident alien?
Yes No
Yes No
12. Do you intend to occupy the property as your
If yes, please answer:
Yes No
Yes No
13. Have you had an ownership interest in a property in the last three years?
Yes No
Yes No
14. What type of property did you own: principal residence (PR), second home (SH), or investment property (IP)?
15. How did you hold title to the home: solely by yourself (S), jointly with your spouse (SP), or jointly with another person (O)?

By submitting this application, I/We certify that this information has been supplied truthfully, accurately and voluntarily, and therefore authorize American Chemcial Society Federal Credit Union (ACSFCU) to investigate our creditworthiness, credit history and financial responsibility through any credit bureau or by any other reasonable means for consideration for the loan applied for, or for any other services offered. I/We understand that this application does not constitute a contract for the extension of credit.

Thank You. Upon receipt of this application, the credit committee at ACSFCU will review your information and respond as quickly as possible to extend credit, to ask additional questions, or to request further information.
We appreciate this opportunity to be your financial partner.

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