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Home Loan Application
An easy, convenient way to apply for a mortgage loan! We will review your application and respond quickly.
Personal Information
Please note that by submitting this application form online, you (and any co-borower who applies) grant permission for Independent Bank to obtain a consumer credit report on any listed borrower or co-borrower.
*First Name:
*Last Name:
Referral Name:
*Home Phone:
( ) -
Cell Phone:
( ) -
Work Phone:
( ) - Ext.
Marital Status:
*Are you a U.S. citizen?
*Date of Birth:
*Social Security :
- -
Years of School:
*Number of Dependents:
Dependent Age(s):
Separate ages by commas.
*Loan Officer:
   How did you hear about us?
Please Specify: 
Current Address
*Street Address:
*Rent or Own:
Loan Details
*Purpose of Loan:
Please Specify  
*Property Usage:
*Loan Amount:
Purchase Price:
Estimated Value:
*Number of Units:
Year Built:
Monthly Income
Submitting income from alimony, child support, or separate maintenance income is optional if you do not want to use that income for qualification purposes.
*Base Income:
Other Income:
Retirement Funds:
Mutual Funds:
Information for Government Monitoring Purposes
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. You may select one or more designations for "Race." The law provides that a lender may not discriminate on the basis of this information, or on whether you choose to furnish it. However, if you choose not to furnish the 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.

* Privacy Policy:

We take our clients' financial privacy very seriously. During the course of processing your application, we accumulate non-public personal financial information from you and from other sources about your income, your assets, and your credit history in order to allow a lender to make an informed decision about granting you credit. We restrict access to nonpublic personal information about you to those employees who need to know that information to provide products or services to you. We maintain physical, electronic, and procedural safeguards that comply with federal regulations to guard your nonpublic personal information.

We collect nonpublic information about you from the following sources: (i) information we receive from you on applications or other forms; (ii) information about your transactions with us, our affiliates, or others; and (iii) information we receive from a consumer reporting agency.

We do not disclose any nonpublic information about our customers or former customers to any third party, except as permitted by law.

Do you have a co-borrower?  
* = Required



Independent Bank
5050 Poplar Avenue, Suite 2200, Memphis, TN  38157
Office:  (901) 844-5050
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