Online Loan Application

Personal Information:

Borrower

^*Full Name:

^*Address:

^*City, State, Zip:

^*Home Phone:

Work Phone:

Best time to contact:

Email:

Social Security #:

Employer:

Employer's Phone Number:

Are you self employed? Yes No

Length of Employment:

Gross Monthly Income:

Date of Birth:

My credit history is: excellent good, but some lates some credit problems major credit problems don't know

Co-Borrower

(if different)

^*Full Name:

^*Address:

^*City, State, Zip:

^*Home Phone:

Work Phone:

Best time to contact:

Email:

Social Security #:

Employer:

Employer's Phone Number:

Are you self employed? Yes No

Length of Employment:

Gross Monthly Income:

Date of Birth:

My credit history is: excellent good, but some lates some credit problems major credit problems don't know

Loan Request:

Amount Requested:

Type of loan:

Property Information:

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

Street Address:

City, State, Zip Code:

Estimated Present Value:

Year Purchased:

Original Price:

Type of Property:

Purchase Amount:

Current Loan Information:

(if applicable)

Mortgage Balances

First:

Second:

Other:

By submitting this on-line application, I/We authorize RIVERSIDE MORTGAGE to check our credit.

Formal consideration for a loan from our bank will require a full, written loan application to be submitted and reviewed before any specific loan terms are considered. The information being submitted here is for informal use only to determine if our bank maintains a mortgage loan program that may be of interest to you. A formal signed application, consisting of complete financial data, will be required after a loan program is discussed and appears to fit one of our loan programs.

* required