Welcome to Integra Mortgage Corp.

1014 East Algonquin Road, Suite #112 ▪ Schaumburg, IL 60173

1-847-794-5000 (phone) ▪ 1-847-794-5001 (fax)

Fill out the simple application below and we will give you the mortgage scenario that best fits your needs. If you have any questions about applying, don't hesitate to call us at 1-847-794-5000.

Name:
Phone:		Required
Email Address:		Required
Question/Comment:

Property Type:		BK or Foreclosure in past 7 years:
Occupancy Status:		Years planning to live in home:

Rate Your Credit:

Monthly Assoc. Fees (if App.):

Purchase Price:

Total Monthly Debt:

Amount of Loan:

Total Gross Monthly Income:

Amount of Down Payment:

BORROWER'S CERTIFICATE AND AUTHORIZATION

The undersigned certifies the following:

1. I/We have applied for a mortgage loan from Integra Mortgage Corp. (“Integra”). In applying for the loan, I/we completed a loan application requesting various items of information for the purpose of the loan, including the amount and source of the down payment, employment, income information, and my/our assets and liabilities. I/We certify that all of the information furnished to Integra is true and complete. I/We made no misrepresentation in the loan application or other documents, nor did I/we omit any pertinent information.
2. I/We understand and agree that Integra reserves the right to change the mortgage loan review process to a full documentation program. This may include verifying the information provided on the application with your employer, financial institutions, the social security administration, and federal, state, and local tax offices, including Form SSA-I099 and other information providers, e.g. pension/profit sharing plan administrators.
3. I/We fully understand that it is a Federal crime punishable by fine or imprisonment, or both, to knowingly make false statements when applying for this mortgage as provided under the provisions of Title 18, United States code, Section 1014.
4. I/We authorize Integra to procure mortgagee clause amendments to our homeowners insurance policy as required by the mortgage lender.

AUTHORIZATION TO RELEASE INFORMATION

To Whom It May Concern:

1. I/We have applied for a loan from Integra. As part of the application process, Integra may verify information contained in my/our loan application and in other documents required in connection with the loan, either before the loan is closed or as part of Integra's quality control program.
2. I/We authorize you to provide to Integra and to any investor to whom Integra may sell my/our mortgage, any and all information and documentation that they request. Such information may include, but is not limited to, employment history and income; bank, money market, and similar account balances; credit history; and copies of filed income tax return. Integra or any investor that purchases the mortgage may address this authorization to any party named in the loan application.
3. A copy of this authorization may be accepted as an original.
4. Your prompt reply to Integra or the investor that purchased the mortgage is appreciated.

AUTHORIZATION FOR THE SOCIAL SECURITY ADMINISTRATION TO RELEASE SOCIAL SECURITY NUMBER VERIFICATION

I authorize the Social Security Administration (SSA) to verify my Social Security number to Integra Mortgage Corp. or its designated lender (“Integra”) through an appointed agent. I understand that my consent allows no additional information from my Social Security records to be provided to Integra and that the verification of my Social Security number will be used to confirm my identity. I also understand that my Social Security number may not be used for any other purpose other than the one stated above, including resale or re-disclosure to other parties. The only other re-disclosure permitted by this authorization is for review purposes to ensure that the appointed agent complies with SSA's consent requirements.

I am the individual (s) to whom the Social Security Number(s) set forth below was issued or that person's legal guardian. I declare and affirm under the penalty of perjury that the information contained herein is true and correct. I know that if I make any representation that I know is false to obtain information from Social Security records, I could be found guilty of a misdemeanor or fined up to $5,000. This SSA consent is valid only for 120 days from the date signed, unless indicated otherwise by the individual named below.

THE BORROWER(S) HAS READ AND UNDERSTANDS THIS DISCLOSURE.

BORROWER:
DATE:
SOCIAL SECURITY #:

Privacy Act Notice: The information to be obtained will be used by the lender and any federal agency insuring, guaranteeing or purchasing the mortgage to determine whether you qualify as a prospective borrower under the lender's and the agency's underwriting standards. The information will not be disclosed outside the lender and the federal agency without your consent except to the person or company verifying the information including, but not limited to, your employer, bank, lender and any other credit reference as needed to verify other credit information and as permitted by law. You do not have to give us this information but if you do not your mortgage loan application may be delayed or rejected. The information we will obtain is authorized by Title 38, U.S.C. Chapter 37 (if VA); and 12 U.S.C., Section 1701 et seq. (if HUD/FHA).

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Regulated By: Illinois Department of Financial and Professional Regulation Division of Banking, 122 S. Michigan Ave., Suite 1900, Chicago IL 60603, 312-793-3000.

An Illinois Residential Mortgage Licensee MB.6760317

A Wisconsin Residential Mortgage Licensee 214038

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