Information Sheet
Helping Area Homebuyers since 1965
INFORMATION NEEDED TO COMPLETE LOAN APPLICATION
1. Copy of Sales Contract & listing for the new home (if a purchase transaction) If you are
refinancing, please provide a copy of the last HUD 1 Settlement statement for your loan.
2. Employment and Residence History for the last two years.
*Name, Address, Account Numbers for your mortgage company or landlord – for past 2 years
3. Copies of the last two months complete bank statements for checking and savings accounts.
4. Copies of last two years Federal Tax Returns – all pages, including W-2, 1099 forms.
*If VHDA, requirements: last three years signed Federal tax returns
*If self employed, requirements: please bring copies of last 2 years business returns
5. Copies of one month’s most recent paystubs.
6. Copies of complete most recent two months statements for any investment accounts (401K,
Profit Sharing, Stocks, Bonds, CDs, IRAs)
7. Copy of Driver’s License.
8. If you pay or receive child support or alimony, please bring a copy of your separation agreement
or divorce decree.
9. If you have previously filed bankruptcy please bring a full copy of your bankruptcy papers.
10. Your Checkbook: A check payable to VILLAGE BANK MORTGAGE to cover cost of appraisal and
credit report in the amount of $434. This can also be paid with VISA or Master Card by calling me
with the credit information after you receive the full application for signature.
THANK YOU FOR APPLYING WITH HELTZEL MORTGAGE
Rob Heltzel, President
Office: 703-368-9248 x 3020
Borrowers Name:
Co-Borrowers Name:
Home Phone:
Home Phone:
E-mail:
E-mail:
Borrowers SS#
Co-Borrowers SS#
Borrowers DOB:
Co-Borrowers DOB:
Married:
Single:
Divorced:
Married:
Single:
Divorced:
Borrowers Yrs. Of School:
Co-Borrowers Yrs. Of School:
Borrowers Current Residence
Co-Borrowers Current Residence
Address:
Address:
Own:
Rent:
Own:
Rent:
Dates of occupancy:
Dates of Occupancy:
Landlord(If Applicable)
Landlord(If Applicable)
*If residing at present address for less than 2
years, complete the next section.
Borrowers Previous Residence
*If residing at present address for less than 2 years,
complete the next section.
Co-Borrowers Previous Residence
Address:
Address:
Own:
Rent:
From:
Own:
To:
Rent:
From:
To:
Landlord(If Applicable)
Borrowers Current Employer
Landlord(If Applicable)
Co-Borrowers Current Employer
Company:
Company:
Address:
Address:
Title:
Title:
Phone:
Fax:
Gross Monthly Income:
Date of hire:
Phone:
Fax:
Gross Monthly Income:
Date of hire:
*If employed in current position for less than 2
years please complete the next section.
*If employed in current position for less than 2 years
please complete the next section.
Borrowers Previous Employer
Co-Borrowers Previous Employer
Company:
Company:
Address:
Address:
Title:
Title:
Phone:
Fax:
Gross Monthly Income:
From:
To:
Automobiles:
Year/Make:
Loan Company:
Market Value:
Monthly Payment:
Loan Balance:
Phone:
Fax:
Gross Monthly Income:
From:
To:
Additional Auto:
Year/Make:
Loan Company:
Market Value:
Monthly Payment:
Loan Balance:
Assets
Asset # 1
Bank Name:
Balance Checking:
Balance Savings:
Asset # 2
Bank Name:
Balance Checking:
Balance Savings:
Non-Retirement
Assets
Retirement (Tax
Deferred)
Stocks and Bonds Value:
401-K Value:
Other Retirement Value:
Liabilities (Include Mortgage Information)
Account # 1
Account Name:
Account # 2
Account # 3
Account # 4
Account # 5
Balance:
Min. Mo. Payment:
Account #:
Account Name:
Balance:
Min. Mo. Payment:
Account #:
Account Name:
Balance:
Min. Mo. Payment:
Account #:
Account Name:
Balance:
Min. Mo. Payment:
Account #:
Account Name:
Balance:
Min. Mo. Payment:
Account #:
Declarations:
1. How will you hold your property title? Solely
Jointly(Married)
Jointly(Unmarried)
2. Do you intend to occupy the property as your primary residence? Yes
*If yes please proceed to the next question.
No
3. Have you had ownership interest in a property in the last 3 years?
*If yes please proceed to the next question.
No
4. What type of property did you own? Principle Residence
5. How did you hold the title to the home? Solely
Yes
Second Home
Jointly(Married)
Investment
Jointly(Unmarried)
6. Do you give Village Bank Mortgage Corporation authorization to pull credit information, and any
other necessary information needed to process your application?
Yes
No