Loan Application | Jason R Smith

Let's Get Started

What type of financing are you looking for?

🏡

Purchase

I'm buying a home

🔄

Refinance

I want a better rate or terms

💰

Home Equity Loan

I want to tap my home's equity

Select an option above to continue — no personal info needed yet.

Loan & Property Information

Tell us about the property and what you're looking for.

Loan Purpose *

Purchase Rate / Term Refi Cash-Out Refi

Subject Property

Street Address *

City

State *

County

ZIP Code *

Property Type *

Property Usage *

Loan Numbers

Purchase Price / Est. Value *

$

Down Payment

$

Loan amount: —

Loan Term *

Amortization *

Borrower Information

Personal details for the primary borrower.

First Name *

Middle Name

Last Name *

Suffix

Social Security Number * Encrypted and stored securely. Used only to obtain a credit report. CA residents: CCPA Privacy Notice →

Date of Birth *

Email Address *

Cell Phone *

Marital Status *

Number of Dependents

Citizenship Status *

U.S. Citizen Permanent Resident Non-Permanent Resident

Adding a Co-Borrower?

Spouse, partner, or joint applicant

Address History

2 years of address history is required for all mortgage applications.

Current Address

Street Address *

City *

State *

ZIP Code *

Own or Rent? *

Monthly Housing Payment

$

Time at This Address *

Employment & Income

Current employer and gross monthly income (before taxes).

Self-Employed?

Business owner, 1099 contractor, or freelancer

Employer / Business Name *

Job Title / Position *

Employment Start Date *

Employer Phone

Employer Address

Monthly Gross Income — From Employment

Base / Wages *

$

Overtime

$

Bonus / Commission

$

Other / Additional Income

Income from outside your current employer — Social Security, rental income, pension, disability, child support, alimony, etc. Do not repeat employment income above.

Other Income Amount

$

Other Income Source

Total Monthly Income (employment + other combined)

$

Assets & Declarations

Approximate balances are fine for the initial application.

Assets (Approximate Balances)

Checking & Savings

$

Retirement / 401k / IRA

$

Stocks / Investments

$

Gift Funds

$

Declarations

Have you declared bankruptcy in the past 7 years?

Have you had a property foreclosed on in the past 7 years?

Are there any outstanding judgments against you?

Are you currently a party to any lawsuits?

Are you currently delinquent or in default on any federal debt?

Review & Submit

Please review your information before submitting.

📋 Federal Mortgage Application Disclosures

Complete Application: This constitutes a complete mortgage application under TILA/Reg Z (12 C.F.R. § 1026.19). Statewide Funding Inc. must provide you a Loan Estimate within 3 business days of receiving this application.

Appraisal Rights (ECOA, 12 C.F.R. § 1002.14): We may order an appraisal and charge you for it. You will receive a copy promptly, even if your loan does not close. You may obtain an additional appraisal at your own cost.

Equal Credit Opportunity (15 U.S.C. § 1691): We may not discriminate based on race, color, religion, national origin, sex, marital status, age, or receipt of public assistance.

📊 Government Monitoring Information (Optional — 12 C.F.R. § 1002.13)

The following information is requested by the Federal Government to monitor lender compliance with equal credit opportunity, fair housing, and home mortgage disclosure laws. You are not required to provide this information. A lender may not discriminate based on this information or your choice not to furnish it.