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Fields marked with an asterisk (*) are required for a borrower. If there is a co-borrower, these fields must be filled in for the co-borrower also. While all other fields are optional, this information will assist us in processing your application more quickly.
Personal Information Borrower Co-borrower
First Name*
Middle Initial*
Last Name*
Social Security Number*
Current Address*
City*
State*
Zip Code*
Home Phone*
Work Phone
Email Address*
Monthly Income Borrower Co-borrower
From First Job $ $
From Second Job $ $
Retirement $ $
Child Support/Alimony $ $
Other $ $
Monthly Debt Payment Borrower Co-borrower
Loans (ex. Auto, student loans) $ $
Credit Cards $ $
Child Suppor/Alimony $ $
Other $ $
Purpose of Loan: Construction  Purchase  Refinance  
Proposed Purchase Price/Refinance Amount $
Down Payment Amount $
Annual Real Estate Taxes $
Provide any additional information here:

I/We authorize Southern Trust Mortgage Company to order an in-file credit report at no cost or obligation to me/us. I/We understand that the information collected will be used only to help determine the best course of action in obtaining home financing.*
(Note: The borrower must agree in order to submit this application form.)

Borrower Authorizes Co-borrower Authorizes