American System Built Mortgage - Division of First National Bank of Chester County

General Information
How did you hear about American System Built Mortgage?
Are you currently working with a Loan Officer?

Borrower Name:*
Co-Borrower Name:

Current Street Address
Address Line 1:*	Address Line 2:
City:*	State:*	Zip Code:*

Rent or Own: RentOwn	How Long?
Selling Home? YesNo	Current Value:
Home Phone:*	Cell Phone:	Email:

Employment Information
Borrower Gross Income:	Borrower Self Employed: YesNo	Borrower Work Phone:
Co-Borrower Gross Income:	Co-Borrower Self Employed: YesNo	Co-Borrower Work Phone:

Current Monthly Payments
Mortgage Payment(s):	Rent Payment(s):	Car Payment(s):
Credit Card(s): (Minimum Monthly Payment)	Student Loan(s):
Other:	Please List:
Other:	Please List:
Other:	Please List:

Details About Your Project
Manufacturer:	Dealer Name:	General Contractor Name:
Primary Home or Second Home: PrimarySecondary	When do you plan to break ground?
Own Land? YesNo	How Many Acres?
Land Value?	Amount Owed?

Subject Property Address Line 1:	Subject Property Address Line 2:
City	State:	Zip Code:

Kit Price:	Total Construction Costs (not including kit price)
Have you paid any deposits for your home? YesNo		If yes, how much?
Livable Square Footage: (Above Grade)	Bedrooms:	Bathrooms:

Credit Authorization
I authorize American SystemBuilt Mortgage ("ASBM") to obtain my credit report from a credit-reporting agency. I also authorize ASBM to provide my credit report to any affiliate or investor of ASBM for their review. I understand that I can obtain this report from a credit-reporting agency in accordance with the Fair Credit Reporting Act. I also understand that if I have questions, disputes or comments about the information on my credit report, I must contact the credit-reporting agency to address these issues. This authorization is not an application for credit nor is it a request to ASBM to consider an application from me for credit.
Borrower's Full Name:	Social Security Number:	Date of Birth:
Co-Borrower's Full Name:	Social Security Number:	Date of Birth:
Questions/Comments:
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