information and you have made this application in person, under federal regulations the lender is required to note ethnicity, race, and sex on the basis of visual observation or surname. If you do not wish to furnish the information, please check below. APPLICANT: CO-APPLICANT: __ I do not wish to furnish this information __ I do not wish to furnish this information Ethnicity: Ethnicity: or Latino or Latino □ Hispanic □ Hispanic or Latino or Latino □ Not Hispanic □ Not Hispanic Race: Race: American Indian or Native American Indian or Native □ □ Asian Asian □ □ Black or African American Black or African American □ □ Native Hawaiian or Other Pacific Islander Native Hawaiian or Other Pacific Islander □ □ White White □ □ Sex: Sex: Female Female □ □ Male Male □ □ Important Please Read – Fair CrEdit Reporting/employment disclosure Any consumer reporting agency is hereby authorized and instructed to compile and furnish to Dollar Bank a credit report to be used in connection with this credit application. Dollar Bank is also authorized to verify my employment history. MORTGAGE APPLICATION DISCLOSURE (REAL ESTATE SECURED LOANS ONLY) This loan will be secured by a mortgage or a deed of trust. You acknowledge that this property will not be used for any illegal or restricted purpose. FALSE STATEMENT Please be on notice that it may be a federal crime to knowingly make any false statements concerning this loan application. I/We certify that the information provided in this application is true and correct as of the date set forth opposite my/our signatures below. ___________________________________________ Date: ____/____/____ Signature Borrower’s ___________________________________________ Date: ____/____/____ Co- Signature Borrower’s
information and you have made this application in person, under federal regulations the lender is required to note ethnicity, race, and sex on the basis of visual observation or surname. If you do not wish to furnish the information, please check below. APPLICANT: CO-APPLICANT: __ I do not wish to furnish this information __ I do not wish to furnish this information Ethnicity: Ethnicity: □ Hispanic or Latino □ Hispanic or Latino □ Not Hispanic or Latino □ Not Hispanic or Latino Race: Race: □ American Indian or Native □ American Indian or Native □ Asian □ Asian □ Black or African American □ Black or African American □ Native Hawaiian or Other Pacific Islander □ Native Hawaiian or Other Pacific Islander □ White □ White Sex: Sex: □ Female □ Female □ Male □ Male Important – Please Read Fair CrEdit Reporting/employment disclosure Any consumer reporting agency is hereby authorized and instructed to compile and furnish to Dollar Bank a credit report to be used in connection with this credit application. Dollar Bank is also authorized to verify my employment history. MORTGAGE APPLICATION DISCLOSURE (REAL ESTATE SECURED LOANS ONLY) This loan will be secured by a mortgage or a deed of trust. You acknowledge that this property will not be used for any illegal or restricted purpose. FALSE STATEMENT Please be on notice that it may be a federal crime to knowingly make any false statements concerning this loan application. I/We certify that the information provided in this application is true and correct as of the date set forth opposite my/our signatures below. ___________________________________________ Date: ____/____/____ Borrower’s Signature ___________________________________________ Date: ____/____/____ Co- Borrower’s Signature
PHRP_0_Application11-29-17.docx