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Apply for a mortgage with JDS Mortgages, LLC.

How we you referred to the JDS website:

Realtor

Personal referral from friend/family

JDS Loan Officer

Other

LOAN OFFICER - Select JDS Officer who has been assisting you.

SECTION I - Borrower Information

Borrower's Name
(Include Jr or Sr if applicable):

Marital Status

Married Separated Unmarried (includes single, divorced, widowed)

Social Security Number:

- -

Date of Birth:

Present Address:

Rent Own

Home Phone Number:

Mobile Phone Number:

Please check if wish this to make your Mobile the primary contact number

Work Phone Number:

Please check if wish this to make Work your primary contact number

Email Address:

Do you hereby authorize JDS Mortgage Services Inc. to obtain your credit report?
yes no

SECTION II - Co-Borrower Information

Co-Borrower's Name
(Include Jr or Sr if applicable):

Married Separated Unmarried (includes single, divorced, widowed)

Social Security Number:

- -

Date of Birth:

Preset Address:

Rent Own

Home Phone Number:

Mobile Phone Number:

Please check if wish this to make your Mobile the primary contact number

Work Phone Number:

Please check if wish this to make Work your primary contact number

Email Address:

Do you hereby authorize Residential Mortgage Services Inc. to obtain your credit report?
yes no

SECTION III - Borrower Employment Information

Name & Address of Employer:

Self Employed

Business Phone (include area code):

Position/Title/Type of Business:

Years on this Job:

If employed in current position for less than two years or if currently employed in more than one position, complete the following:

Name & Address of Employer:

Business Phone (include area code):

Position/Title/Type of Business:

Years on this Job:

SECTION IV - Co-Borrower Employment Information

Name & Address of Employer:

Self Employed?

Business Phone (include area code):

Position/Title/Type of Business:

Years on this Job:

SECTION V - Monthly Income and Combined Housing Expense Information

Gross Monthly Income	Borrower	Co-Borrower	Total
Base Employment Income: Weekly Wages Before Taxes & Deductions multiplied by 52 Weeks) divided by 12 months	$	$	$
Overtime:	$	$	$
Bonuses:	$	$	$
Commissions:	$	$	$
Dividends/Interest:	$	$	$
Net Rental Income:	$	$	$
Other 1: (Please explain) (*before completing see the notice below - Click Here	$	$	$
Other 2: (Please explain)	$	$	$
TOTAL	$	$	$
* Describe Other Income - 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 Expenses	Present
Rent:	$
First Mortgage (P&I):	$
Other Financing (P&I):	$
Hazard Insurance:	$
Real Estate Taxes:	$
Mortgage Insurance:	$
Homeowner Assn. Dues:	$
Other:	$
TOTAL	$

SECTION VI - Assets

Type

Account Number

Cash or Market Value

Name and Address of Bank, S&L, or Credit Union

Name:
Address:
City:
State:
Zip:

Name:
Address:
City:
State:
Zip:

Name:
Address:
City:
State:
Zip:

Type

Account Number

Cash or Market Value

Name and Address of Company

Name:
Address:
City:
State:
Zip:

Name:
Address:
City:
State:
Zip:

SECTION VII - Select Liabilities and Declarations

Do you pay Alimony, Child Support, or Separate Maintenance Payments?

Owed To:

Amount:

Do you currently own other property? Yes

If yes

Second Home

Rental Property

Are there any outstanding judgments against you?	Yes \| No
Have you been declared bankrupt within the past 7 years?	Yes \| No
Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?	Yes \| No
Are you a party to a lawsuit?	Yes \| No
Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment? (This would include such loans as home mortgage loans, SBA loans, home improvement loans, education loans, manufactured home loans, any mortgage, financial obligation, bond, or loan guarantee.)	Yes \| No
Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee?	Yes \| No
Are you obligated to pay alimony, child support, or separate maintenance?	Yes \| No
Is any part of the down payment borrowed?	Yes \| No
Are you a co-maker or endorser on a note?	Yes \| No
Are you a U.S. citizen?	Yes \| No
Are you a permanent resident alien?	Yes \| No
Do you intent to occupy the property as your primary residence?	Yes \| No

Section VIII - Acknowledgment and Agreement

The undersigned specifically acknowledge(s) and agree(s) that: (1) the loan requested by this application will be secured by a first mortgage or deed of trust on the property described herein; (2) the property will not be used for any illegal or prohibited purpose or use; (3) all statements made in this application are made for the purpose of obtaining the loan indicated herein; (4) occupation of the property will be as indicated above; (5) verification or reverification of any information contained in this application may be made at any time by the Lender, its agents, successors and assigns, either directly or through a credit reporting agency, from any source named in this application, and the original copy of this application will be retained by the Lender, even if the loan is not approved; (6) the Lender, its agents, successors and assigns will rely on the information continued in the application and I/we have a continuing obligation to amend and/or supplement the information provided in this application if any of the material facts which I/we have represented herein should change prior to closing; (7) in the event my/our payments on the loan indicated in this application become delinquent, the Lender, its agents, successors and assigns, may, in addition to all their other rights and remedies, report my/our name(s) and account information to a credit reporting agency; (8) ownership of the loan may be transferred to successor or assign of the Lender without notice to me and/or the administration of the loan account may be transferred to an agent, successor or assign of the Lender with prior notice to me; (9) the Lender, its agents, successors and assigns make no representations or warranties, express or implied, to the Borrower(s) regarding the property, the condition of the property, or the value of the property.

Right to Receive Copy of Appraisal: I/We have the right to a copy of the appraisal report used in connection with this application for credit. To obtain a copy, I/we must send Lender a written request at the mailing address Lender has provided. Lender must hear from me/us no later than 90 days after Lender notified me/us about the action taken on this application, or I/we withdraw this application.

Certification: I/We certify that the information provided in this application is true and correct as of the date set forth opposite my/our name below on this application and acknowledge my/our understanding that any intentional or negligent misrepresentation(s) of the information contained in this application may result in civil liability and/or criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States code, Section 1001, et seq. and liability for monetary damages to the Lender, its agents, successors and assigns, insurers and any other person who may suffer any loss due to reliance upon any misrepresentation which I/we have made on this application.

BY TYPING YOUR NAME IN THE DIGITAL SIGNATURE SECTION BELOW YOU ACKNOWLEDGE AND AGREE TO SECTION VIII ABOVE.

Date:	/ /
Borrower Digital Signature:

Registered representative of and securities offered through ING Financial Partners. J.D. Stewart Financial, Inc., is not a subsidiary or not controlled by ING Financial Partners, Inc. Member SIPC.

Licensed by the New Hampshire Banking Department.
Also, Licensed by the Maine, Massachusetts, and Florida Banking Department.

ME Lic # CSO5710, NH Lic # 9678MBR, Ma Lic # MB3486, FL Lic # MBB0500521