1. Applicant's Information   Applicant's Full Name: Co-Applicant's Full Name: Current Residency Type: Own Rent Street Address: City: State: Zip Code: Home Phone: Work Phone: Best Time to Contact: Daytime Evening Email:   2. Employment / Income Information   Primary Applicant   Current Employer: Years with Current Employer: Yearly Income (before taxes): Please Rate Your Credit: - Select an Option - Bad Excellent Fair Good   Co-Applicant (If Applicable)   Current Employer: Years with Current Employer: Yearly Income (before taxes): Please Rate Your Credit: - Select an Option - Bad Excellent Fair Good   3. Loan Information   Desired Loan Amount: Loan Type: - Select an Option - Purchase Refinance Are You a First-time Home Buyer? - Select an Option - No Yes   4. Comments   Any extra comments or specifics you would like to add: Comment:

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*Disclaimer: Loans are subject to borrower qualifications, including income, property evaluation, sufficient equity in the home to meet Loan-to-Value requirements, and final credit approval. Approvals are subject to underwriting guidelines, interest rates, and program guidelines and are subject to change without notice based on applicant’s eligibility and market conditions. Refinancing an existing loan may result in total finance charges being higher over the life of a loan. Reduction in payments may reflect a longer loan term. Terms of any loan may be subject to payment of points and fees by the applicant. SecurityNational Mortgage Co. is an Equal Opportunity Lender. NMLS#3116