Mortgage Loan Request form: PURCHASE

Phone: 516-349-4247
Fax: 866-691-2913
Email: phoward@bethpagefcu.com
Borrower Information
Borrower Name: Co-Borrower Name:
Present Address: Present Address:
City: State: Zip Code: City: State: Zip Code:
Own: Rent: # of Years: Own: Rent: # of Years:
Total Current Monthly Housing Payment: $ Total Current Monthly Housing Payment: $
Preferred Contact: Preferred Contact:
Phone: Email: Phone: Email:
Phone (incl. area code): Phone (incl. area code):
E-Mail Address: E-Mail Address:
Social Security Number: Social Security Number:
Date of Birth: Date of Birth:
Marital Status: Married Separated Unmarried Marital Status: Married Separated Unmarried
Years School: Dependents: Ages: Years School: Dependents: Ages:
Estimated Credit Rating: Estimated Credit Rating:
Excellent Very Good Good Fair Poor Excellent Very Good Good Fair Poor
800+ 740-799 670-739 580-669 579 & Lower 800+ 740-799 670-739 580-669 579 & Lower

Desired Property Information

Property Type: SFR 2-4 Unit Condo Coop PUD Other:
Purchase Price: $ Loan Amount: $ Annual Property Taxes: $
Monthly Maintenance Fee (Condo/Coop/PUD): $ Do you have a fully executed Contract of Sale? Y N
Property will be: Primary Residence Secondary Residence Investment

Employment Information (a two year history will be required prior to finalizing your application)
Employer: Employer:
Employer Address: Employer Address:
City: State: Zip Code: City: State: Zip Code:
Business Phone (incl. area code): Business Phone (incl. area code):
Position: Self Employed: Y N Position: Self Employed: Y N
Annual Gross Income: $ Annual Gross Income: $
Start Date: Years Employed in Profession: Start Date: Years Employed in Profession:
Additional/Other Income (SSI, Pension, Alimony, Child Support) Additional/Other Income (SSI, Pension, Alimony, Child Support)
Source: Annual Amount: $ Source: Annual Amount: $
Note: alimony, child support, or separate income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

Source of Funds Used for Transaction

Checking/Savings Money Market CD Retirement Brokerage Gift Sale of Present Home
Total Balance: $

Real Estate Owned

Do you own any other real estate? Y N
If yes, property address:
Annual Taxes: $ Annual Homeowners Insurance: $ Monthly Maintenance Fee: $
Monthly Mortgage Payment: $ Mortgage Balance: $ Will property be: Sold or Held

Acknowledgement and Agreement

Each of the borrower(s) 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 request is true and correct as of the date completed and that any intentional or negligent misrepresentation of this information contained in this request 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 request, 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 request (the “Loan”) will be secured by a mortgage or deed of trust on the property described in this request; (3) the property will not be used for any
illegal or prohibited purpose or use; (4) all statements made in this request are made for the purpose of obtaining a residential mortgage loan; (5) the property will be occupied as indicated in this request; (6) the Lender, its servicers,
successors or assigns may retain the original and/or an electronic record of this request, 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 request, and I am obligated to amend and/or supplement the information provided in this request 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 required 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
request as an “electronic record” as that term is defined in applicable federal and/or state laws (excluding audio and video recordings), or my facsimile transmission of this request, shall be as effective, enforceable and valid as if
a paper version of this request were delivered. Acknowledgement. Each of the borrower(s) hereby acknowledges that any owner of the Loan, its servicers, successors and assigns, may verify or reverify any information contained in
this request or obtain any information or data relating to the Loan, for any legitimate business purpose through any source, including a source named in this request or a consumer reporting agency. In order to complete your request
to finance a mortgage loan, Bethpage Federal Credit Union will request a credit report which includes credit scores. This information is used to analyze your past and present credit performance. I/we expressly authorize Bethpage
Federal Credit Union and its agent to investigate my credit worthiness, employment history (work record), and to obtain a credit report, and other information about me from consumer reporting agencies and other sources. I/we also
authorize Bethpage Federal Credit Union to use such information for other purposes, including to administer, review or renew my account(s), for credit line increases or decreases, for collection and other servicing of my account(s),
for other credit-related purposes connected with my account(s), to offer other products and services, and for any other uses permitted by law.

Date: Applicant:

Date: Co-Borrower: