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Short Mortgage Form
Our short mortgage form is an easy and fast way to request a mortgage. Please provide the following information.
Personal Information
*First Name:
*Middle Name:
*Last Name:
*Email:
*Referral Name:
*Home Phone:
( ) -
Cell Phone:
( ) -
Work Phone:
( ) - Ext.
*Marital Status:
Are you a U.S. citizen?
*Date of Birth:
 (mm/dd/yyyy)
*Social Security or Tax ID #:
- -
*Credit Check Authorization:
Number of Dependents:
Dependent Age(s):
Separate ages by commas.
*Loan Officer:
   How did you hear about us?
Please Specify: 
 
Current Address
*Street Address:
*City:
*State:
*Zip:
-
Years at this Address:
 Years     Months
Rent or Own:
 
Subject Property
*Purpose of Loan:
Please Specify  
*Property Usage:
Loan Amount:
$
Purchase Price:
$  
Estimated Value:
$  
 
Monthly Income
Submitting income from alimony, child support, or separate maintenance income is optional if you do not want to use that income for qualification purposes.
*Base Income:
$
Bonuses:
$
Commission:
$
Other Income:
$
 
Assets
Checking:
$
Savings:
$
Retirement Funds:
$
Mutual Funds:
$
Other:
$
 
Demographic Information
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:




For example: Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on.

   
Race - Check one or more:
Enter name of enrolled or principal tribe:








For example: Hmong, Laotian, Thai, Pakistani, Cambodian, and so on.






For example: Fijian, Tongan, and so on.

   
Sex:


Co-Borrower
Do you have a co-borrower?  
* = Required

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Lincoln Savings Bank
3254 Kimball Ave, Waterloo, IA  50701
Office:  (319) 233-0013
mortgage@mylsb.com
Copyright © 2019 Lincoln Savings Bank and LSB Financial.
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