Please fill out the fields in the form below. One of our representatives will contact you within one business day to complete the process.

This form supports the maximum level of encryption technology your browser allows, up to 256-bit SSL encryption to protect your personal information while it is in transit. Please view our Privacy Notice for more information.

Lender: Matt Brown

Single or Joint Application

  • Is this a single or joint application?

    OKIs this a single or joint application? is required

Personal Information

  • OKName is required
  • OKDate of Birth is required
  • OKSocial Security Number is required
  • OKHome Phone/Cell Phone is required
  • OKWork Phone is required
  • OKE-mail is required
  • OKNumber of Dependents is required
  • Marital Status

    OKMarital Status is required
  • OKYears at Current Residence is required
    OKOwn is required
    OKRent is required
  • OKAddress is required
  • OKCity is required
  • OKState is required
  • OKZip is required
  • OKCurrent Employer is required
  • OKYears at Employer is required
  • OKPosition/ Title is required
  • OKType of Business is required
  • OKPrevious Employer (if less than 2 years at current employer) is required
  • OKYears at Employer is required
  • OKPosition/ Title is required
  • OKType of Business is required

Co - Applicant Personal Information

  • OKName is required
  • OKDate of Birth is required
  • OKSocial Security Number is required
  • OKHome Phone/Cell Phone is required
  • OKWork Phone is required
  • OptionalOKE-mail is required
  • OKNumber of Dependents is required
  • Marital Status

    OKMarital Status is required
  • OKYears at Current Residence is required
    OKOwn is required
    OKRent is required
  • OKAddress is required
  • OKCity is required
  • OKState is required
  • OKZip is required
  • OKCurrent Employer is required
  • OKYears at Employer is required
  • OKPosition / Title is required
  • OKType of Business is required
  • OKPrevious Employer (if less than 2 years at current employer) is required
  • OKYears at Employer is required
  • OKPosition / Title is required
  • OKType of Business is required

Income

    Gross income

  • OKAnnual Salary (if applicable) is required
  • OKHourly Wage (if applicable) is required
  • OKAverage Hours Worked Per Week is required
  • OKOvertime is required
  • OKBonus is required
  • OKCommission is required
  • OKOther is required
  • (Child Support, Alimony or Separate Maintenance Income Need not be disclosed if you do not wish to have it considered as a basis for repaying a mortgage. Self–Employed Borrowers must submit previous 2 years tax returns for consideration)

Co - Applicant Income

    Gross income

  • OKAnnual Salary (if applicable) is required
  • OKHourly Wage (if applicable) is required
  • OKAverage Hours Worked Per Week is required
  • OKOvertime is required
  • OKBonus is required
  • OKCommission is required
  • OKOther is required
  • (Child Support, Alimony or Separate Maintenance Income Need not be disclosed if you do not wish to have it considered as a basis for repaying a mortgage. Self–Employed Borrowers must submit previous 2 years tax returns for consideration)

Realtor and Builder Information

  • OKRealtor / Builder is required
  • OKReal Estate Company is required
  • OKBuilder is required

Debts

  • OKCurrent Housing Payment is required
  • OKTotal Monthly Revolving Payments (i.e.: credit card, line of credit) is required
  • OKTotal Monthly Installment Payments (i.e.: auto loan, student loan) is required
  • OKOther is required
  • OKAlimony / Child Support is required
  • OKTotal is required

Co - Applicant Debts

  • OKCurrent Housing Payment is required
  • OKTotal Monthly Revolving Payments (i.e.: credit card, line of credit) is required
  • OKTotal Monthly Installment Payments (i.e.: auto loan, student loan) is required
  • OKOther is required
  • OKAlimony / Child Support is required
  • OKTotal is required

Assets

  • OKApproximate Checking Account Balance is required
  • OKApproximate Savings Account Balance is required
  • OKGift Funds Available is required

Additional Information

  • Are there any outstanding judgments against you?

    OKAre there any outstanding judgments against you? is required
  • Have you been declared bankrupt within the past 7 years?

    OKHave you been declared bankrupt within the past 7 years? is required
  • Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?

    OKHave you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years? is required
  • Are you a party to a lawsuit?

    OKAre you a party to a lawsuit? is required
  • Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee?

    OKAre you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee? is required
  • Are you obligated to pay alimony, child support, or separate maintenance?

    This section asks about your ethnicity, sex, and race.OKAre you obligated to pay alimony, child support, or separate maintenance? is required

Demographic Information Addendum

    The purpose of collecting this information is to help ensure that all applicants are treated fairly and that the housing needs of communities and neighborhoods are being fulfilled. For residential mortgage lending, federal law requires that we ask applicants for their demographic information (ethnicity, sex, and race) in order to monitor our compliance with equal credit opportunity, fair housing, and home mortgage disclosure laws. You are not required to provide this information, but are encouraged to do so. You may select one or more designations for "Ethnicity" and one or more designations for "Race." The law provides that we may not discriminate on the basis of this information, or on whether you choose to provide it. However, if you choose not to provide the information and you have made this application in person, Federal regulations require us to note your ethnicity, sex, and race on the basis of visual observation or surname. The law also provides that we may not discriminate on the basis of age or marital status information you provide in this application. If you do not wish to provide some or all of this information, please check below.

  • Ethnicity: Check one or more

    OKEthnicity: Check one or more is required
  • Sex

    OKSex is required
  • Race: Check one or more

    OKRace: Check one or more is required

Co - Applicant

  • Ethnicity: Check one or more

    OKEthnicity: Check one or more is required
  • Sex

    OKSex is required
  • Race: Check one or more

    OKRace: Check one or more is required

    THE UNDERSIGNED AGREE THAT ALL STATEMENTS MADE IN THIS APPLICATION ARE MADE FOR THE PURPOSE OF OBTAINING A PRE– QUALIFIED CERTIFICATE FOR A MORTGAGE FROM THE FIRST STATE BANK. THE BANK RESERVES THE RIGHT TO VERIFY OR REVERIFY ANY OR ALL INFORMATION AT ANY TIME INCLUDING THE USE OF A CREDIT REPORTING AGENCY OR FROM ANY SOURCE STATED ABOVE. THE BANK RELIED ON THE INFORMATION PROVIDED TO MAKE A DECISION AND IF FUTURE VERIFICATION OR REVERIFICATION REVEALS A CHANGE IN THE INFORMATION PROVIDED, THE BANK RESERVES THE RIGHT TO ALTER THEIR ORIGINAL PRE–QUALIFICATION DECISION.

    By checking the Applicant and/or Co–Applicant boxes/ the applicant and/or co–applicant agree to let The First State Bank pull their credit records in relation to their mortgage loan application, as described in the following paragraph.

    Applicant and/or Co–Applicant authorize The First State Bank to make whatever credit inquiries it deems necessary in connection with this application or in the course of review of collection of any credit extended in reliance on the application. Applicant and/or Co–Applicant authorize and instruct any person or consumer reporting agency to compile and furnish to the Bank any information it may have or obtain in response to such credit inquiries and agree that same shall remain your property whether or not credit is extended. Applicant and/or Co–Applicant are hereby notified that a consumer report was requested, and if such report was requested. Applicant and/or Co–Applicant will be informed of the name and address of the consumer reporting agency that furnished the report. Subsequent consumer reports may be requested or utilized in connection with an update, renewal or extension of credit.

    CERTIFICATION: The undersigned certify that the information provided in this application is true and accurate to the best of their ability and acknowledge that any misrepresentation may result in the Lender's denial of the application.

    USA PATRIOT ACT: Important Information About Opening a New Account To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account.

    What This Means For You: When you open an account, we will ask for your name, address, date of birth and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.

    OKApplicant is required
    OKApplicant and Co-Applicant is required

Electronic Delivery of Loan Documents / Notices Consent and Agreement

Security Code

  • OK is required
  • The First State Bank reserves the right to use the above information to obtain verifications of identity and background before opening any accounts. We may also access information about you from a consumer reporting agency, such as a copy of your credit report, before opening any account. By submitting this form, you grant full permission to do so.