Credit Application Uniform Residential Loan Application Verify and complete the information on this application. If you are applying for this loan with others, each additional Borrower must provide information as directed by your Lender 1Borrower Information2Assets and Liabilities3Real Estate4Loan and Property5Declarations6Agreements7Military Service8Demographics9Verification This section asks about your personal information and your income from employment and other sources, such as retirement, that you want considered to qualify for this loan.Personal InformationName(Required) First Middle Last Suffix Alternate Names List any names by which you are known or any names under which credit was previously receivedFirstMiddleLastSuffix Add RemoveSocial Security Number(Required) (or Individual Taxpayer Identification Number)Date of Birth(Required) Month Day Year Citizenship(Required) U.S. Citizen Permanent Resident Alien Non-Permanent Resident Alien Type of Credit(Required) I am applying for individual credit. I am applying for joint credit Total Number of BorrowersEach Borrower intends to apply for joint credit.Your initialsIf applying for joint credit, both borrowers must submit an application Marital Status(Required) Married Separated Unmarried (Single, Divorced, Widowed, Civil Union, Domestic Partnership, Registered Reciprocal Beneficiary Relationship) Number of Dependents (not listed by another Borrower)(Required)Ages of Dependents Home PhoneCell PhoneEmail Work PhoneExt. Current Address(Required) Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How Long at Current Address?(Required)Housing(Required) No primary housing expense Own Rent Rent(Required)Former Address(Required) Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How Long at Former Address?(Required)Housing(Required) No primary housing expense Own Rent Rent(Required)Is Mailing Address different from Current Address Is Mailing Address different from Current Address Mailing Address(Required) Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Current Employment/Self-Employment and IncomeEmployer or Business Name Position or Title PhoneAddress Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Start Date Month Day Year How long in this line of work?Check if this statement applies: I am employed by a family member, property seller, real estate agent, or other party to the transaction. Gross Monthly IncomeBaseOvertimeBonusCommissionMilitary EntitlementsOtherTotalBusiness Owner or Self-Employed? Check if you are the Business Owner or Self-Employed Business Ownership Type(Required) I have an ownership share of less than 25% I have an ownership share of 25% or more Monthly Income (or Loss)(Required)Additional Employment/Self-Employment and IncomeEmployer or Business Name Position or Title PhoneAddress Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Start Date Month Day Year How long in this line of work?Check if this statement applies: I am employed by a family member, property seller, real estate agent, or other party to the transaction. Gross Monthly IncomeBaseOvertimeBonusCommissionMilitary EntitlementsOtherTotalBusiness Owner or Self-Employed? Check if you are the Business Owner or Self-Employed Business Ownership Type(Required) I have an ownership share of less than 25% I have an ownership share of 25% or more Monthly Income (or Loss)(Required)Business Tax ID# Business Organization Sole LLC Corp Previous Employment/Self-Employment and IncomeProvide at least 2 years of current and previous employment and income.Employer or Business Name Address Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Position or Title Start Date Month Day Year End Date Month Day Year Business Owner or Self-Employed? Check if you were the Business Owner or Self-Employed Previous Gross Monthly IncomeIncome from Other SourcesInclude income from other sources below. Under Income Source, choose from the sources listed here Alimony Child Support Interest and Dividends Notes Receivable Royalty Payments Unemployment Automobile Allowance Disability Mortgage Credit Certificate Public Assistance Separate Maintenance Benefits Boarder Income Foster Care Mortgage Differential Retirement Social Security VA Compensation Capital Gains Housing or Parsonage Payments (e.g., Pension, IRA) Trust Other NOTE: Reveal alimony, child support, separate maintenance, or other income ONLY IF you want it considered in determining your qualification for this loan.ListIncome Source – Use list aboveMonthly Income Add RemoveProvide TOTAL Amount Here This section asks about things you own that are worth money and that you want considered to qualify for this loan. It then asks about your liabilities (or debts) that you pay each month, such as credit cards, alimony, or other expenses.Assets – Bank Accounts, Retirement, and Other Accounts You HaveInclude all accounts below. Under Account Type, choose from the types listed here: Checking Savings Money Market Certificate of Deposit Mutual Fund Stocks Stock Options Bonds Retirement (e.g., 401k, IRA) Bridge Loan Proceeds Individual Development Account Trust Account Cash Value of Life Insurance (used for the transaction) ListAccount Type – use list aboveFinancial InstitutionAccount NumberCash or Market Value Add RemoveProvide TOTAL Amount HereOther Assets and Credits You HaveInclude all other assets and credits below. Under Asset or Credit Type, choose from the types listed here:Assets Proceeds from Real Estate Property to be sold on or before closing Proceeds from Sale of Non-Real Estate Asset Unsecured Borrowed Funds Secured Borrowed Funds Other Credits Earnest Money Relocation Funds Sweat Equity Employer Assistance Rent Credit Trade Equity Lot Equity ListAsset or Credit Type – use list aboveCash or Market Value Add RemoveProvide TOTAL Amount HereLiabilities – Credit Cards, Other Debts, and Leases that You OweList all liabilities below (except real estate) and include deferred payments. Under Account Type, choose from the types listed here: Revolving (e.g., credit cards) Installment (e.g., car, student, personal loans) Open 30-Day (balance paid monthly) Lease (not real estate) Other ListAccount Type – use list aboveCompany NameAccount NumberUnpaid BalanceTo be paid off at or before closingMonthly Payment Add RemoveOther Liabilities and ExpensesInclude all other liabilities and expenses below. Choose from the types listed here: Alimony Child Support Separate Maintenance Job Related Expenses Other ListLiability Type – use list aboveMonthly Payment Add Remove This section asks you to list all properties you currently own and what you owe on them.Property You OwnIf you are refinancing, list the property you are refinancing FIRST.Address Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code ListProperty ValueStatus: Sold, Pending Sale, or RetainedIntended Occupancy: Investment, Primary Residence, Second Home, OtherMonthly Insurance,Taxes, Association Dues, etc. if not included in Monthly Mortgage PaymentMonthly Rental Income (For 2-4 Unit Primary or Investment Property)For LENDER to calculate: Net Monthly Rental Income (For 2-4 Unit Primary or Investment Property) Add RemoveMortgage Loans on this PropertyCreditor NameAccount NumberMonthly Mortgage PaymentUnpaid BalanceTo be paid off at or before closingType: FHA, VA, Conventional, USDA-RD, OtherCredit Limit (if applicable) Add RemoveAdditional PropertyAddress Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code ListProperty ValueStatus: Sold, Pending Sale, or RetainedIntended Occupancy: Investment, Primary Residence, Second Home, OtherMonthly Insurance,Taxes, Association Dues, etc. if not included in Monthly Mortgage PaymentMonthly Rental Income (For 2-4 Unit Primary or Investment Property)For LENDER to calculate: Net Monthly Rental Income (For 2-4 Unit Primary or Investment Property) Add RemoveMortgage Loans on this PropertyCreditor NameAccount NumberMonthly Mortgage PaymentUnpaid BalanceTo be paid off at or before closingType: FHA, VA, Conventional, USDA-RD, OtherCredit Limit (if applicable) Add RemoveAdditional PropertyAddress Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code ListProperty ValueStatus: Sold, Pending Sale, or RetainedIntended Occupancy: Investment, Primary Residence, Second Home, OtherMonthly Insurance,Taxes, Association Dues, etc. if not included in Monthly Mortgage PaymentMonthly Rental Income (For 2-4 Unit Primary or Investment Property)For LENDER to calculate: Net Monthly Rental Income (For 2-4 Unit Primary or Investment Property) Add RemoveMortgage Loans on this PropertyCreditor NameAccount NumberMonthly Mortgage PaymentUnpaid BalanceTo be paid off at or before closingType: FHA, VA, Conventional, USDA-RD, OtherCredit Limit (if applicable) Add Remove This section asks about the loan’s purpose and the property you want to purchase or refinance.Loan and Property InformationLoan Amount(Required)Loan Purpose(Required) Purchase Refinance Other Property Address(Required) Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Number of Units(Required)Property Value(Required)Occupancy Primary Residence Second Home Investment Property FHA Secondary Residence FHA Secondary Residence Mixed-Use Property?(Required)If you will occupy the property, will you set aside space within the property to operate your own business? (e.g., daycare facility, medical office, beauty/barber shop) Yes No Manufactured Home?(Required)Is the property a manufactured home? (e.g., a factory built dwelling built on a permanent chassis) Yes No Other New Mortgage Loans on the Property You are Buying or RefinancingListCreditor NameLien Type (First Lien / Subordinate Lien)Monthly PaymentLoan Amount/ Amount to be DrawnCredit Limit (if applicable) Add RemoveRental Income on the Property You Want to PurchaseComplete if the property is a 2-4 Unit Primary Residence or an Investment PropertyExpected Monthly Rental IncomeFor LENDER to calculate: Expected Net Monthly Rental IncomeGifts or Grants You Have Been Given or Will Receive for this LoanInclude all gifts and grants below. Under Source, choose from the sources listed here: Community Nonprofit Employer Federal Agency Local Agency Relative Religious Nonprofit State Agency Unmarried Partner Lender Other ListAsset Type: Cash Gift, Gift of Equity, GrantDeposited/Not DepositedSource – use list aboveCash or Market Value Add Remove This section asks you specific questions about the property, your funding, and your past financial history.About this Property and Your Money for this LoanWill you occupy the property as your primary residence?(Required) Yes No Have you had an ownership interest in another property in the last three years?(Required) Yes No What type of property did you own?(Required) Primary residence (PR) FHA secondary residence (SR) Second home (SH) Investment property (IP) How did you hold title to the property?(Required) By yourself (S) Jointly with your spouse (SP) Jointly with another person (O) If this is a Purchase Transaction: Do you have a family relationship or business affiliation with the seller of the property? Yes No Are you borrowing any money for this real estate transaction (e.g., money for your closing costs ordown payment) or obtaining any money from another party, such as the seller or realtor, that you have not disclosed on this loan application?(Required) Yes No What is the amount of this money?(Required)Have you or will you be applying for a mortgage loan on another property (not the property securing this loan) on or before closing this transaction that is not disclosed on this loan application?(Required) Yes No Have you or will you be applying for any new credit (e.g., installment loan, credit card, etc.) on or before closing this loan that is not disclosed on this application?(Required) Yes No Will this property be subject to a lien that could take priority over the first mortgage lien, such as a clean energy lien paid through your property taxes (e.g., the Property Assessed Clean Energy Program)?(Required) Yes No About Your FinancesAre you a co-signer or guarantor on any debt or loan that is not disclosed on this application?(Required) Yes No Are there any outstanding judgments against you?(Required) Yes No Are you currently delinquent or in default on a Federal debt?(Required) Yes No Are you a party to a lawsuit in which you potentially have any personal financial liability?(Required) Yes No Have you conveyed title to any property in lieu of foreclosure in the past 7 years?(Required) Yes No Within the past 7 years, have you completed a pre-foreclosure sale or short sale, whereby the property was sold to a third party and the Lender agreed to accept less than the outstanding mortgage balance due?(Required) Yes No Have you had property foreclosed upon in the last 7 years?(Required) Yes No Have you declared bankruptcy within the past 7 years?(Required) Yes No Identify the type(s) of bankruptcy(Required) Chapter 7 Chapter 11 Chapter 12 Chapter 13 This section tells you about your legal obligations when you sign this application.Consent(Required)Definitions:“Lender” includes the Lender’s agents, service providers, and any of their successors and assigns.“Other Loan Participants” includes (i) any actual or potential owners of a loan resulting from this application (the “Loan”), (ii) acquirers of any beneficial or other interest in the Loan, (iii) any mortgage insurer, (iv) any guarantor, (v) any servicer of the Loan, and (vi) any of these parties’ service providers, successors or assigns.I agree to, acknowledge, and represent the following:The Complete Information for this ApplicationThe information I have provided in this application is true, accurate, and complete as of the date I signed this application.If the information I submitted changes or I have new information before closing of the Loan, I must change and supplement this application, including providing any updated/supplemented realestate sales contract.For purchase transactions: The terms and conditions of any real estate sales contract signed by me in connection with this application are true, accurate, and complete to the best of my knowledge and belief. I have not entered into any other agreement, written or oral, inconnection with this real estate transaction.The Lender and Other Loan Participants may rely on the information contained in the application before and after closing of the Loan.Any intentional or negligent misrepresentation of information may result in the imposition of:(a) civil liability on me, including monetary damages, if a person suffers any loss because the person relied on any misrepresentation that I have made on this application, and/or(b) criminal penalties on me including, but not limited to, fine or imprisonment or both under the provisions of Federal law (18 U.S.C. §§ 1001 et seq.).The Property’s SecurityThe Loan I have applied for in this application will be secured by a mortgage or deed of trust which provides the Lender a security interest in the property described in this application.The Property’s Appraisal, Value, and ConditionAny appraisal or value of the property obtained by the Lender is for use by the Lender and Other Loan Participants.The Lender and Other Loan Participants have not made any representation or warranty, express or implied, to me about the property, its condition, or its value.Electronic Records and SignaturesThe Lender and Other Loan Participants may keep any paper record and/or electronic record of this application, whether or not the Loan is approved.If this application is created as (or converted into) an “electronic application”, I consent to the use of “electronic records” and “electronic signatures” as the terms are defined in and governed byapplicable Federal and/or state electronic transactions laws.I intend to sign and have signed this application either using my:(a) electronic signature; or(b) a written signature and agree that if a paper version of this application is converted into an electronic application, the application will be an electronic record, and the representationof my written signature on this application will be my binding electronic signature.I agree that the application, if delivered or transmitted to the Lender or Other Loan Participants as an electronic record with my electronic signature, will be as effective and enforceable as a paper application signed by me in writing.DelinquencyThe Lender and Other Loan Participants may report information about my account to credit bureaus. Late payments, missed payments, or other defaults on my account may be reflected in my credit report and will likely affect my credit score.If I have trouble making my payments I understand that I may contact a HUD-approved housing counselling organization for advice about actions I can take to meet my mortgage obligations.Authorization for Use and Sharing of InformationBy signing below, in addition to the representations and agreements made above, I expressly authorize the Lender and Other Loan Participants to obtain, use, and share with each other (i) the loan application and related loan information and documentation, (ii) a consumer credit report on me, and (iii) my tax return information, as necessary to perform the actions listed below, for so long as they have an interest in my loan or its servicing:(a) process and underwrite my loan;(b) verify any data contained in my consumer credit report, my loan application and other information supporting my loan application;(c) inform credit and investment decisions by the Lender and Other Loan Participants;(d) perform audit, quality control, and legal compliance analysis and reviews;(e) perform analysis and modeling for risk assessments;(f) monitor the account for this loan for potential delinquencies and determine any assistance that may be available to me; and(g) other actions permissible under applicable law. I agree to the privacy policy.Borrower Signature(Required) Reset signature Signature locked. Reset to sign again Date(Required) Month Day Year Additional Borrower Signature Reset signature Signature locked. Reset to sign again Date Month Day Year This section asks questions about your (or your deceased spouse’s) military service.Military Service of BorrowerDid you (or your deceased spouse) ever serve, or are you currently serving, in the United States Armed Forces?(Required) Yes No Check all that apply: Currently serving on active duty with projected expiration date of service/tour Currently retired, discharged, or separated from service Only period of service was as a non-activated member of the Reserve or National Guard Surviving spouse Projected expiration date of service/tour Month Day Year This section asks about your ethnicity, sex, and race.Demographic Information of BorrowerThe 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 belowEthnicity(Required)Check one or more Hispanic or Latino Not Hispanic or Latino I do not wish to provide this information sub choices for Hispanic or Latino(Required) Mexican Puerto Rican Cuban Other Hispanic or Latino Origin Sex(Required) Female Male I do not wish to provide this information Race American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White I do not wish to provide this information Print name of enrolled or principal tribe Asian Region Asian Indian Chinese Filipino Japanese Korean Vietnamese Other Asian Other Asian RaceFor example: Hmong, Laotian, Thai, Pakistani, Cambodian, and so on. Pacific Islander Region Native Hawaiian Guamanian or Chamorro Samoan Other Pacific Islander Other Pacific Islander RaceFor example: Fijian, Tongan, and so on. To Be Completed by Financial Institution (for application taken in person):Was the ethnicity of the Borrower collected on the basis of visual observation or surname?(Required) Yes No Was the sex of the Borrower collected on the basis of visual observation or surname?(Required) Yes No Was the race of the Borrower collected on the basis of visual observation or surname?(Required) Yes No The Demographic Information was provided through: Face-to-Face Interview (includes Electronic Media w/ Video Component) Telephone Interview Fax or Mail Email or Internet To help the government fight the funding of terrorism and money laundering activities, Federal law is now requiring all financial institutions to obtain, verify and record information that identifies each person who opens an account. What this means to you: When you apply for a loan through One West Associates, Inc, we will ask for your name, address, date of birth and other information that will allow us to identify you (this is asked on the first page of the application). We may also ask to see and retain a copy of an unexpired government- issued photo I.D. or other identifying documents. This information being requested and observed is for compliance with the requirements of Section 326 of the USA Patriot Act implementing customer identification and verification requirements. The information in no way will be used in making the credit decision on your completed application.Customer Name: (Individual Name)(Required) In what country are you a citizen?(Required)AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land IslandsHow long do you expect to be in the U.S.?(Required) Do you have permission to work in the U.S.?(Required) Yes No Are you, or any of your family members, or associates connected to the government of a country other than the U.S.?(Required) Yes No Will any of the transactions on this account originate or have a destination outside the U.S.?(Required) Yes No Business Entity Profile QuestionnaireDo you sell, issue, or redeem money orders, travelers checks or cashiers checks?(Required) Yes No If yes, what is the maximum amount for one individual during a business day?(Required) Do you cash checks?(Required) Yes No If yes, what is the maximum amount cashed for one individual during a business day?(Required) Are you a currency dealer or exchanger?(Required) Yes No If yes, what is the maximum amount for one individual during a business day?(Required) Do you offer wire transfers?(Required) Yes No Will you be doing any foreign wires (incoming or outgoing)?(Required) Yes No Are your registered as a Money Service Business (MSB) with the sate of Missouri?(Required) ***(Money Service Business must complete Money Service Business Questionnaire. MSB’s must show proof of registration and BSA policy before account is opened, retain copies of each)*** Yes No Are you currently or do you anticipate operating any entertainment enterprises online, any gaming operations online, or any gambling operations online?(Required) Yes No Do you have a privately owned ATM?(Required) Yes No Will any financial transactions affecting this account originate or have destination outside the U.S.?(Required) Yes No Business Name(Required) Form Completed by(Required) CommentsThis field is for validation purposes and should be left unchanged. Δ
