Please complete the following information to the best of your ability. If you cannot complete one of the questions for whatever reason please move on to the questions you can answer, we will contact you if additional information is required.

You may submit this application electronically or you may print it out and submit it by fax to 316-219-2155. You may also submit this application over the phone by calling 316-945-2155. Or simply email us with your phone number and we'll call you. Please don't hesitate to contact us with any questions you may have. Thank you for choosing Kansas Mortgage Center.

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Loan Purpose
Purchase
Refinance

Loan Amount $

Property Type
Primary Residence
Second Home
Investment Property (Not owner-occupied)

 

Property Address
Street:
City:
State:
Zip:
Property Value:

 

	BORROWER	CO BORROWER
Contact Information
E-Mail Address
First Name, MI, Last Name
Home Telephone Number
Work Telephone Number
Birthday (MMDDYY)
Social Security Number
Marital Status
Previous Address
(Complete only if you've lived at present address for less than two years.)
Previous Street Address
City, State, Zip
Own or Rent	Own Rent
Present Employment
Present Employer
Address
City, State, Zip
Start Date
Gross Monthly Income
Title
Previous Employment
(Complete only if employed less than two years by present employer.)
Previous Employer
Address
City, State, Zip
Dates Employed
Gross Monthly Income
Title
Other income (if any)
Other Income Source
How Long Receiving
Monthly Amount
Other Income Source
How Long Receiving
Monthly Amount
Please Note: Alimony, child support, or separate maintenance income need not be revealed if you do not wish it to be considered as a basis for repaying this obligation.

 

Asset Information

(please complete for all checking, savings, money market, CD, stock, bond or other liquid asset accounts)

 

Bank or Institution Name
	Checking Balance
	Savings Balance
	Money Market
	401 K
	IRA