Marital Status:*
State Issued:*
Contact Method:*
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Is there a joint applicant?
The following information is requested by the Federal Government for certain types of loans related
to a dwelling, in order to monitor the Lender's compliance with equal credit opportunity, fair housing
and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so.
The law provides that a Lender may neither discriminate on the basis of this information,
nor on whether you choose to furnish it. However, if you choose not to furnish it, under Federal regulations
this Lender is required to note race and sex on the basis of visual observation or surname. If you do not wish
to furnish the above information, please check the box below. (Lender must review the above material to assure
that the disclosure satisfy all requirements to which the Lender is subject under applicable state law for the
particular type of loan applied for.)
Details for Applicant:
Ethnicity:*
Race/National Origin:
Select:*
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