Mortgage Information

If you are applying for joint credit, secured credit, or if you live in a community property state (AZ, CA, ID, LA, NM, NV, TX, WA, WI, Puerto Rico), please complete the loan type.

• Loan Type
  Mortgage Home Equity
• Application Type *
  Individual Joint
• Amount *
• Purpose *
• What brought you here today? *
  Select One Facebook Website Ad Front Line Referral Loan Officer Referral Other Referral

Applicant Information

• Full Name *
• Account Number
• Social Security Number *
• Date of Birth *
• Email *
• Home Phone *
• Current Address *
• City *
• State *
  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• Zip *
• Address Since *
• Reference (Secondary Person of Contact) *

Employment Information

Please Note: In order to process your application we will need the following documentation: 30 days of paycheck stubs, 2 months of bank statements, and if self-employed or retired: financial statement or income tax returns. Please forward this information via fax at (217) 223-4391 or email at mortgagelending@membersfirstccu.com.

• Employer Name *
• Employer Phone
• Employer Address
• Position
• Date Hired
• Monthly Gross Income (USD) *
• If not currently employed, source of income

Previous Employer

• Previous Employer Name
• Years Employed

Applicant

• Mortgage/Rent
•  
  Own Rent None
• Payment 2
  Payment 2 Creditor Payment 2 Amount
• Payment 3
  Payment 3 Creditor Payment 3 Amount
• Payment 4
  Payment 4 Creditor Payment 4 Amount
• Payment 5
  Payment 5 Creditor Payment 5 Amount
• Payment 6
  Payment 6 Creditor Payment 6 Amount
• Payment 7
  Payment 7 Creditor Payment 7 Amount
• Payment 8
  Payment 8 Creditor Payment 8 Amount

Information for Government Monitoring Purposes

The following information is requested by the federal government for certain types of loans related 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. You may select one or more designations for "Race". The law provides that a lender may not discriminate on the basis of this information, or on whether you choose to furnish it. However, if you choose not to furnish the information and you have made this application in person, under federal regulations the lender is required to note ethnicity, race, and sex on the basis of visual observation or surname. If you do not wish to furnish the information, please check below.

Primary Applicant

• Do not disclose
  I do not wish to furnish this information
• Ethnicity
  Hispanic or Latino Not Hispanic or Latino
• Race
  American Indian, Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White
• Sex
  Male Female