Loan Application

Centurion Funding Corp

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How much house can I afford?

For more information about Centurion Funding Corp services, please fill out the following form. One of our mortgage associates will respond as promptly as possible. NOTE: Before you submit the application, please print a copy from your browser.

Loan Information

What program do you want?:

How much money can you put down?:

How is your credit?: If you don't know your credit scores, I'll get that for you FREE!

Enter your organization ID (if applicable):

Loan Information

Loan Purpose:	Property Type:
Loan Type:	Preferred Interest Rate:
Loan Amount:	Property Value/Purchase Price:
Down Payment:
Property Address:
City State, Zip Code:

Borrower Information

First Name:	M.I.:	Last Name:
Social Security Number:		Marital Status:
Home Phone Number:		Email Address:
Age:		Years of School:
Date of Birth: Month/Day/Year //

Co-Borrower Information

I have a co-borrower:
First Name:	M.I.:	Last Name:
Social Security Number:		Marital Status:
Home Phone Number:		Email Address:
Age:		Years of School:
Date of Birth: (MM/DD/YYYY) //

Current Address Information

Use this address for co-borrower

Current Address:

City, State Zip Code:

Years at address:

Months at address:

Do you Own, Rent or Live Rent Free:

Mailing Address

Mailing Address:

City, State Zip Code:

Country:

Years at address:

Months at address:

Do you Own, Rent or Live Rent Free:

Previous Address Information

Use this address for co-borrower

Previous Address:

City, State Zip Code:

Years at address:

Months at address:

Do you Own, Rent or Live Rent Free:

Current Employment Information

Check here if you are retired or do not draw income

Current Employer:

Employer's Address:

City State, Zip Code:

Position or Title:

Work Phone Number:

Time with employer:
Years Months

Years in this line of work:

Are you self employed:

Secondary/Previous Employment Information

Current Employer Previous Employer

Employer's Name:

Employer's Address:

City State, Zip Code:

Work Phone Number:

Your position:

Monthly Income:

Date employed from: (mm/dd/yyyy)

Date employed to: (mm/dd/yyyy)

Are you self employed:

Current Borrower Income Information

Monthly Base Income before Taxes:
$

Average monthly Overtime before taxes:
$

Average monthly Bonuses before Taxes:
$

Average monthly Commissions before Taxes:
$

Average monthly dividend/interest income before Taxes:
$

Other monthly income:
$

Description of Other monthly income:

Borrower Declarations

		YES	NO
1	Are there any judgments against you?
2	Have you declared bankruptcy in the past 7 years?
3	Have you had a property foreclosed upon or given a deed in lieu of foreclosure in the past 7 years?
4	Are you party to a lawsuit?
5	Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu or foreclosure of judgment ? (This would include such loans as home mortgage loans, SBA loans, home improvement loans, educational loans, manufactured (mobile) home loans, any mortgages, financial obligation, bond, or loan guarantees.)
6	Are you presently delinquent on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee?
7	Are you obligated to pay alimony, child support, or separate maintenance?
8	Is or will any part of the down payment borrowed?
9	Are you a co-maker or endorser on any other person's obligation(s)? (This question does not apply to your spouse if he/she is to be a co-borrower on the subject transaction)
10	Do you intend to occupy this subject property as your primary residence?
11	If yes, have you had an ownership interest in a property in the past 3 years?
12	If yes, what type or property did you own?
13	How is the title held on your previous property?
14	What is your citizenship?

Government Monitoring

The following information is requested by the Federal Government for certain types of loans relating to a dwelling, in order to monitor the Lender's compliance with equal credit opportunity, fair housing, and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a lender may neither discriminate on the basis of this information, nor on whether you choose to furnish it. However, if you choose not to furnish it, under Federal Regulation, this Lender is required to note race and sex based on visual observation or surname.

Do you wish to provide information regarding your race, national origin, or sex?

What is your sex?

What is your Ethnicity?

If Other, Please specify

Race: (choose all that apply)
hold the ctrl key down to select multiple.

Borrower Assets

	Bank Name:	Account Number:	Cash or Market Value:
Bank 1
Bank 2
Bank 3
Bank 4
Bank 5

Stocks & Bonds

	Company Name:	Number:	Cash or Market Value:
Company 1
Company 2
Company 3
Company 4
Company 5

Other Assets

	Type of Asset	Cash or Market Value:
Vested interest in Retirement Fund:
Net worth of business(es) owned:
Automobile 1.
Automobile 2.
Automobile 3.
Other 1.
Other 2.
Other 3.

Borrower Liabilities

	Company Name:	Account Number:	Unpaid Balance:	Monthly Payment:
Debt 1.
Debt 2.
Debt 3.
Debt 4.
Debt 5.
Debt 6.
Debt 7.
Debt 8.
Debt 9.
Debt 10.

Other Liabilities

Other Liabilities	Monthly Payment:
Alimony:
Child Support:
Separate Maintenance:
Job Related Expenses:

Mortgage Information

Current Housing Expense		Proposed Mortgage Loan
Rent:
OR
First Mortgage (P & I)		First Mortgage (P & I)
Other Financing (P & I)		Other Financing
Hazard Insurance		Hazard Insurance
Real Estate Taxes		Real Estate Taxes
Mortgage Insurance		Mortgage Insurance
Homeowners Dues		Homeowners Dues
Other Expenses		Other Expenses

Real Estate Owned Information

Property 1.
Street:		Market Value:
City State, Zip		Mtg Pmt:
Property Type:		Mtg Liens:
Property 2.
Street:		Market Value:
City State, Zip		Mtg Pmt:
Property Type:		Mtg Liens:
Property 3.
Street:		Market Value:
City State, Zip		Mtg Pmt:
Property Type:		Mtg Liens:

Add comments for your broker or lender

Acknowledgement & Agreement

The undersigned specifically acknowledge(s) and agree(s) that: (1) The loan requested by this application will be secured by a first mortgage or deed of trust on the property. Described herein; (2) the property will not be used for any illegal or prohibited purpose or use; (3) all statements made in this application are made for the purpose of obtaining the loan indicated herein; (4) occupation of the property will be as indicated above; (5) verification or re-verification of any information contained in the application may be made at any time by the lender, its agents, successors and assigns, either directly or through a credit reporting agent, from any source named in this application, and the original copy of this application will be retained by the lender, even if the loan is not approved; (6) the lender, its agents, successors and assigns will rely on the information contained in the application and I/we have a continuing obligation to amend and/or supplement the information provided in this application if any of the material facts which I/we have represented herein should change prior to closing; (7) in the event my/our payments on the loan indicated in this application become delinquent, the lender, its agents, successors and assigns, may, in addition to all their other rights and remedies, report my/our name(s) and account information to a credit reporting agency; (8) ownership of the loan may be transferred to successor or assign of the lender without notice to me and/or the administration of the loan account may be transferred to an agent, successor or assign of the lender with prior notice to me; (9) the lender, its agents, successors and assigns make no representations or warranties, expressed or implied, to the borrower(s) regarding the property, the condition of the property, or the value of the property. I/We have the right to a copy of the appraisal report used in connection with this application for credit. To obtain a copy, I/We must send Lender a written request at the mailing address Lender has provided. Lender must hear form me/us no later than 90 days after Lender notifies me/us about the action taken on this application, or I/We withdraw this application. I/we certify that the information provided in this application is true and correct as of the date set forth opposite my/our signature(s) on this application and acknowledge my/our understanding that my intentional or negligent misrepresentation(s) of the information contained in this application may result in civil liability and/or criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of title 18, United States Code, Section 1001, et seq. and liability for monetary damages to the lender, its agents, successors and assigns, insurers and any other person who may suffer any loss due to the reliance upon any misrepresentation which I/we have made on this application.

Borrower Acknowledgement	Co-Borrower Acknowledgement

I hereby authorize Centurion Funding Corp to verify my past and present employment, earnings records, bank accounts, stock holdings and any other asset balances needed to process my mortgage application.

I further authorize Centurion Funding Corp. to order a mortgage credit report and verify all other credit information, including past an present mortgage and landlord references. The information obtained will only be used in the processing of your loan application.

Borrower Name: Date:

Co-Borrower Name: Date:

As a service to our customers, we provide information that may help you or your business. Please check the items you would like to receive information about.

Information about TaxBack Life Insurance Property Insurance Information about Selling my home

Add me to your email list

Once you have completed this expression of interest (or application) your information will be sent to Claretta Webb at Centurion Funding Corporation. Claretta Webb or a representative from the company may contact you by telephone. By submitting your expression of interest you are consenting to receive telephone calls from the company regarding this application.

Massachusetts License # MC0124