Short Loan Application Harvard State Bank

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Short Loan Application

Getting Started Online

Welcome to our secure online pre-qualification form.

Borrower Information

Full Name(Required)

First Middle Initial Last

Date of Birth

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Home Phone(Required)

Business Phone

Mobile/Page/Alternate

Fax

Contact Me at

Best Time to Call

Total Gross Yearly Income (Income Before Taxes)

*Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.
Notice: Alimony, child support, or separate maintenance income need not be revealed if the Borrower(B) or Co- Borrower(C) does not choose to have it considered for repaying this loan.

Current Employer(Required)

Number of Years(Required)

Co-Borrower Information

Will there be a co-borrower on this loan?

No Co-Borrower

Spouse

Other

Full Name

First Middle Initial Last

Date of Birth

Referred by

First Last

Loan Originator

If you would like to work with a specific loan originator, please select the name above.

Loan Information

Loan Purpose

Property Type

Purchase Price(Required)

Amt Avail for Down Payment on Closing Costs(Required)

Your Message