* Required fields

Introduction

Do you have a co-borrower? *

Do you intend to apply for joint credit? *

Borrower:      
Co-borrower:
 
Authorization to Receive Electronic Disclosures:*

In order to successfully process your mortgage loan application, you must agree to receive certain disclosures from this institution in electronic form rather than paper form. You must also agree to the terms of the E-Sign Loan Consent Agreement, which includes your responsibility to maintain and provide a valid email address. Certain disclosures may be provided to you in paper form as necessary once your mortgage loan application is received.

 

Type of Mortgage and Terms of Loan

$

Property Information and Purpose of Loan

Subject Property Address:

Complete this section if construction, construction-permanent, or refinance loan.

$
$
Describe Improvements:
$

Borrower Information

Borrower's Marital Status:
Do you own or rent at your present address?

If residing at present address for less than two years, complete the section below for your previous residence address.

Did you own or rent at your previous address?

Demographic Information

The 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 data-parsley-required="true" 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 below.

 
Borrower's Ethnicity
(check one or more):
 
Borrower's Race
(check one or more):
Borrower's Sex:

Co-Borrower Information

Co-Borrower's Marital Status:
Do you own or rent at your present address?

If residing at present address for less than two years, complete the section below for your previous residence address.

Did you own or rent at your previous address?

Demographic Information

The 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 data-parsley-required="true" 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 below.

 
Co-Borrower's Ethnicity
(check one or more):
 
Co-Borrower's Race
(check one or more):
Co-Borrower's Sex:

Borrower's Employment Information

Are you self-employed?*
Have you, the Borrower, been in the current position for more than 2 years?
$

$

Co-Borrower's Employment Information

Are you self-employed?*
Have you, the Borrower, been in the current position for more than 2 years?
$

$

Monthly Income and Combined Housing Expense Information

Gross Monthly Income *

Base Empl. Income
$
$
Total:
$0
Social Security/ Retirement
$
$
Total:
$0
Overtime
$
$
Total:
$0
Bonuses
$
$
Total:
$0
Commissions
$
$
Total:
$0
Dividends/Interest
$
$
Total:
$0
Net Rental Income
$
$
Total:
$0
Other
(describe below)
$
$
Total:
$0
Total
$0
$0
$0

Notice: Alimony, child support, or separate maintenance income need not be revealed if the Borrower or Co-Borrower does not choose to have it considered for repaying this loan.

Combined Monthly Housing Expense

Rent
$
First Mortgage (Principal and Interest)
$
Second Mortgage (Principal and Interest)
$
Hazard Insurance
$
Real Estate Taxes
$
Mortgage Insurance
$
Homeowner Assn. Dues
$
Other
$
Total
$0

Assets and Liabilities

List checking and savings accounts below

$
$
$
$
$
$
 
Total:
 
$0

ADD ANOTHER BANK ACCOUNT You can only declare six (6) bank accounts.

Do you have investment or retirement accounts?
 
Do you have Life Insurance?
Life Insurance
$
$
 

Schedule of Real Estate Owned

$
$
Mortgage on First Real Estate Owned Property?
$
$
2nd Mortgage on First Real Estate Owned Property?
$
$
 
Total:
 
$0
$
$
Mortgage on Second Real Estate Owned Property?
$
$
2nd Mortgage on Second Real Estate Owned Property?
$
$
 
Total:
 
$0
$
$
Mortgage on Third Real Estate Owned Property?
$
$
2nd Mortgage on Third Real Estate Owned Property?
$
$
 
Total:
 
$0

ADD ANOTHER PROPERTY You can only declare three (3) real estate properties owned.


$
$
$
$
$
$

ADD ANOTHER AUTOMOBILE You can only declare five (5) automobiles.


Do you have other assets to declare?
$
$
$
$
$

ADD ANOTHER ASSET You can only declare five (5) assets.

Total Assets:
 
$0
 
$
 
Other Liabilities (Credit cards, vehicles, student loans, etc.)
$
$
$
$
$
$
$
$
$
$
$
$

ADD ANOTHER LIABILITY You can only declare six (6) liabilities.

 
Total:
 
$0
Total:
 
$0
Are you obligated to pay child support?
$
 
Are you obligated to pay Alimony/Separate Maintenance?
$
 

Total Liabilities

Amount:
$0

Net Worth

Total Assets minus Total Liabilities:
$0

Declarations

 
Borrower
Co-Borrower
Are there any outstanding judgments against you?
Are there any outstanding judgments against the Borrower?
Are there any outstanding judgments against the Co-Borrower?
Have you been declared bankrupt within the past 7 years?
Has the Borrower been declared bankrupt within the past 7 years?
Has the Co-Borrower been declared bankrupt within the past 7 years?
Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?
Has the Borrower had property foreclosed upon or given title or deed in lieu thereof in the last 7 years? Borrower
Has the Co-Borrower had property foreclosed upon or given title or deed in lieu thereof in the last 7 years? Co-Borrower
Are you a party to a lawsuit?
Is the Borrower a party to a lawsuit?
Is the Co-Borrower a party to a lawsuit?
Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment?
Has the Borrower directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment?
Has the Co-Borrower directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment?
Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee?
Are you, the Borrowerpresently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee?
Are you, the Co-Borrower, presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee?
Are you obligated to pay alimony, child support, or separate maintenance?
Are you, theBorrower,obligated to pay alimony, child support, or separate maintenance?
Are you, theCo-Borrower, obligated to pay alimony, child support, or separate maintenance?
Is any part of the down payment borrowed? Are you a co-maker or endorser on a note?
Is any part of the down payment borrowed? Is theBorrower a co-maker or endorser on a note?
Is any part of the down payment borrowed? Is theCo-Borrower a co-maker or endorser on a note?
Are you a co-maker or endorser on a note?
Is the Borrower a co-maker or endorser on a note?
Is the Co-Borrower a co-maker or endorser on a note?
Are you a U.S. citizen?
Is the Borrower a U.S. citizen?
Is the Co-Borrower a U.S. citizen?
Are you a permanent resident alien?
Is the Borrower a permanent resident alien?
Is the Co-Borrower a permanent resident alien?
Do you intend to occupy the property as your primary residence? If “yes”, complete the questions below.
Does the Borrower intend to occupy the property as your primary residence? If “yes”, complete the questions below.
Does the Co-Borrower intend to occupy the property as your primary residence? If “yes”, complete the questions below.
Have you had an ownership interest in a property in the last three years?
Has the Borrower had an ownership interest in a property in the last three years?
Has the Co-Borrower had an ownership interest in a property in the last three years?

Loan Application Addendum for Individual Relationship - Borrower

Date of Loan Application Reference

Applicant

Government-issued ID

Applicant's Employment
 

Account Activity

What will be the method used for repayment of the loan?
Sources of Income:
Do you anticipate any wire activity through Community Bank?
$

Senior Foreign Political Official

Are you a current or former Senior Foreign Political Official or family member/close associate of one?
What is the status of the Senior Foreign Political Official?
Does the Senior Foreign Political Official have access to government funds with the ability to conduct transactions?

Loan Application Addendum for Individual Relationship - Co-Borrower

Date of Loan Application Reference

Applicant

Government-issued ID

Co-Borrower Applicant's Employment
 

Account Activity

What will be the method used for repayment of the loan by the Co-Borrower?
Co-Borrower Sources of Income:
Do you, the Co-Borrower, anticipate any wire activity through Community Bank?
$

Senior Foreign Political Official

Are you, the Co-Borrower, a current or former Senior Foreign Political Official or family member/close associate of one?
What is the status of the Co-Borrower Senior Foreign Political Official?
Does the Co-Borrower Senior Foreign Political Official have access to government funds with the ability to conduct transactions?

Acknowledgment and Agreement

 

Each of the undersigned specifically represents to Lender and to Lender’s actual or potential agents, brokers, processors, attorneys, insurers, servicers, successors, and assigns and agrees and acknowledges that: (1) the information provided in this application is true and correct as of the date set forth opposite my signature and that any intentional or negligent misrepresentation of this information contained in this application may result in civil liability, including monetary damages, to any person who may suffer any loss due to reliance upon any misrepresentation that I have made on this application, and/or in criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Sec.1001, et seq.; (2) the loan requested pursuant to this application (the “Loan”) will be secured by a mortgage or deed of trust on the property described in this application; (3) the property will not be used for any illegal or prohibited purpose or use; (4) all statements made in this application are made for the purpose of obtaining a residential mortgage loan; (5) the property will be occupied as indicated in this application; (6) the Lender, its servicers, successors or assigns may retain the original and/or an electronic record of this application, whether or not the Loan is approved; (7) the Lender and its agents, brokers, insurers, servicers, successors, and assigns may continuously rely on the information contained in the application, and I am obligated to amend and/or supplement the information provided in this application if any of the material facts that I have represented herein should change prior to closing of the Loan; (8) in the event that my payments on the Loan become delinquent, the Lender, its servicers, successors or assigns may, in addition to any other rights and remedies that it may have relating to such delinquency, report my name and account information to one or more consumer reporting agencies; (9) ownership of the Loan and/or administration of the Loan account may be transferred with such notice as may be data-parsley-required="true" by law; (10) neither Lender nor its agents, brokers, insurers, servicers, successors or assigns has made any representation or warranty, express or implied, to me regarding the property or the condition or value of the property; and (11) my transmission of this application as an “electronic record” containing my “ electronic signature” as those terms are defined in applicable federal and/or state laws (excluding audio and video recordings), or my facsimile transmission of this application containing a facsimile of my signature, shall be as effective, enforceable and valid as if a paper version of this application were delivered containing my original written signature.

Acknowledgment. Each of the undersigned hereby acknowledges that any owner of the Loan, its servicers, successors and assigns, may verify or reverify any information contained in this application or obtain any information or data relating to the loan, for any legitimate business purpose through any source, including a source named in this application or a consumer reporting agency.

Do you agree with the above information?

E-Sign Loan Consent Agreement

Please read this E-Sign Loan Consent Agreement carefully and retain a copy for your records.
This E-Sign Loan Consent Agreement applies to all initial disclosures, loan documents, appraisals and agreements related to the loan account(s) for which you are applying and will be effective until expressly withdrawn by you.

Electronic Delivery of Disclosures, Loan Documents, and Notices
By agreeing to the terms of the E-Sign Loan Consent Agreement, you are consenting to receive electronically all disclosures, notices, terms and conditions and any documents related to your loan application. The specific documents and disclosures will be provided electronically following your acceptance of this E-Sign Loan Consent Agreement and confirmation of your ability to access the documents. You understand and consent that no documents will be mailed to you, unless you specifically submit a request. To request a paper copy, please refer to the section below titled “Withdrawal of Electronic Acceptance of Disclosures, Loan Documents, and Notices”.

You also confirm that your computer or electronic device is able to receive, open and store any such documents you have elected to receive electronically via e-mail. You agree to maintain a valid, active e-mail address. You must promptly notify us of any change in your e-mail or postal address by contacting us in writing, by telephone or e-mail, as noted below.

Opening and Saving PDFs
To open and save portable document format (PDF) files, you must install the free Adobe Reader software.

Withdrawal of Electronic Acceptance of Disclosures, Loan Documents, and Notices
There are no fees to withdraw your consent. You may withdraw your consent at any time by contacting us in writing at Community Bank, P.O. Box 4876, Topeka, KS 66614 or by telephone at (785) 440-4400 or e-mail at communitybank@communitybanktopeka.com. Such withdrawal will become effective upon confirmation by us of the request. Upon termination, you understand and agree that you will no longer receive the documents electronically but will receive them in paper form via the postal mail service.

Do you agree with the above information?

Privacy Notice

What does Community Bank - Topeka, Kansas do with your personal information?

Why?
Financial companies choose how they share your personal information. Federal law gives consumers the right to limit some but not all sharing. Federal law also requires us to tell you how we collect, share, and protect your personal information. Please read this notice carefully to understand what we do.

What?
The types of personal information we collect and share depend on the product or service you have with us. This information can include:
- Social Security number and income
- Account balances and transaction history
- Credit history and payment history
When you are no longer our customer, we continue to share your information as described in this notice.

How?
All financial companies need to share customers’ personal information to run their everyday business. In the section below, we list the reasons financial companies can share their customers’ personal information; the reasons Community Bank chooses to share; and whether you can limit this sharing.

Reasons we can share your personal information.
For our everyday business purposes - such as to process your transactions, maintain your account(s), respond to court orders and legal investigations, or report to credit bureaus.
Does Community Bank share? Yes
Can you limit this sharing? No

For our marketing purposes - to offer our products and services to you.
Does Community Bank share? Yes
Can you limit this sharing? No

For joint marketing with other financial companies.
Does Community Bank share? No
Can you limit this sharing? We don't share

For our affiliates’ everyday business purposes - information about your transactions and experiences.
Does Community Bank share? Yes
Can you limit this sharing? No

For our affiliates’ everyday business purposes - information about your creditworthiness.
Does Community Bank share? No
Can you limit this sharing? We don't share

For nonaffiliates to market to you.
Does Community Bank share? No
Can you limit this sharing? We don't share

Questions?
Call 785-440-4400 or go to communitybank@communitybanktopeka.com

Who we are.
Who is providing this notice?
Community Bank – Topeka, Kansas

What we do.
How does Community Bank protect my personal information?
To protect your personal information from unauthorized access and use, we use security measures that comply with federal law. These measures include computer safeguards and secured files and buildings.

How does Community Bank collect my personal information?
We collect your personal information, for example, when you
- Open an account or deposit money
- Pay your bills or apply for a loan
- Use your debit card We also collect your personal information from others, such as credit bureaus, affiliates, or other companies.
We also collect your personal information from others, such as credit bureaus, affiliates, or other companies.

Why can’t I limit all sharing?
Federal law gives you the right to limit only
- sharing for affiliates’ everyday business purposes - information about your creditworthiness
- affiliates from using your information to market to you
- sharing for nonaffiliates to market to you
State laws and individual companies may give you additional rights to limit sharing.

Definitions
Affiliates
Companies related by common ownership or control. They can be financial and nonfinancial companies.
- Our affiliates include companies with a common corporate identity of financial institutions, such as Community Bancorp, Inc. and Gardner Bancshares, Inc.

Nonaffiliates
Companies not related by common ownership or control. They can be financial and nonfinancial companies.
- Community Bank does not share with nonaffiliates so they can market to you.

Joint marketing
A formal agreement between nonaffiliated financial companies that together market financial products or services to you.
- Community Bank doesn’t jointly market.

Do you agree with the above information?

S.A.F.E. Act
Registered Residential Mortgage Loan Originators

Effective August 1, 2011, federal registrant information will be made publicly available through the Nationwide Mortgage Licensing System and Registry Consumer Access website: “www.NMLSConsumerAccess.org”. Profile information relating to Community Bank of Topeka, Kansas, and the following registered mortgage loan originators will be accessible on this website.

Institution:
Community Bank, Topeka, Kansas

Unique Identifier Number:
401256

Mortgage Loan Originators:
Barnard, Barbara J.401378
Earling, Tracy401379
Haggard, Calla C.401380
Weigel, Anne K.401383
Mitchell, Troy767453
Propps, Lisa D.1543381
Armstrong, Nicholas R.1543422

Do you agree with the above information?

Service Provider List

Additional Details for Services You Can Shop For
To get you started with shopping, this list identifies some providers for the services you can shop for.
Service Provider List: (You can select this provider or shop for your own provider.)
Service: Lenders Title Policy
Estimate: $325-$1200
Provider We Identified: Security 1st Title LLC
Contact Information: 2655 SW Wanamaker, Topeka KS 66614, (785) 272-2900

Additional Services You Can Shop, NOT Required By Lender:

  • Owners Title Policy
  • Home Warranty
  • Pest
  • Whole House
  • Waste Water
  • Radon
  • Survey
  • Electrical
  • Fireplace/Chimney
  • Sewer Cam
  • HVAC
  • Foundation
  • Roof
Do you agree with the above information?

Federal Credit Application Insurance Disclosure

I have applied for an extension of credit with you. You are soliciting, offering, or selling me an insurance product or annuity in connection with this extension of credit. FEDERAL LAW PROHIBITS YOU FROM CONDITIONING THE EXTENSION OF CREDIT ON EITHER:

  1. My purchase of an insurance product or annuity from you or from any of your affiliates; or
  2. My agreement not to obtain, or a prohibition on me from obtaining, an insurance product or annuity from an unaffiliated entity.

By signing, I acknowledge that I have received a copy of this form on today’s date. Unless this disclosure is provided electronically or I have applied for credit by mail, I also acknowledge that you have provided this disclosure to me orally.

Do you agree with the above information?

Notice of Right to Receive Copy of Appraisals

We may order an appraisal to determine the property's value and charge you for this appraisal. We will promptly give you a copy of any appraisal, even if your loan does not close.

You can pay for an additional appraisal for your own use at your own cost.

Do you agree with the above information?
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Thank You

Thank you for submitting your loan application to Community Bank.  A member of our team will contact you within one business day.  Please remember, at a minimum they will be requesting:
 
  • Last two years W-2s
  • Last two years tax returns, if you are self employed
  • One month of current pay-stubs
  • Driver’s license copy for each applicant