To better serve our customers needs, we now offer an interactive 1003 Uniform Residential Loan Application that enables you to type in your information. After entering all of the data required, you can print copies for signatures and fax or deliver to our office. If you need assistance or have trouble with any of the documents, please call us at (434) 447-3200.
The below documents can be viewed and printed directly from your web browser. Simply click on the pdf icon  link to the right of the applicable forms. While this is a complete version of the 1003 form, the formatting has been altered to accommodate web viewing.
Please note: the Uniform Residential Loan Application Form 1003 is a legal size document. Please print on legal size paper or shrink to letter size. You can also fill in our loan application form below with your loan information and a representative will contact you.


Uniform Residential Loan Application (Interactive)


Uniform Residential Loan Application (Standard)


Borrower’s Authorization


Borrower Broker Agreement


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Loan Application Form:

 Applicant Information:

* First Name & M.I.      * Last Name  
Co-Applicant Name  
Street Address  
* City     * State   * Zip  
* Email Address     Must be a valid Email Address  (ie. yourname@your isp)
Day Time Phone      Evening Phone
Best Time to Call    
*  Social Security Number      (example: 222-55-8888)
Co-Applicant SS#     (example: 222-55-8888)
 Loan Information:
Desired Loan Amount  
Purpose of loan  
Type of 1st Mortgage  
1st Mortgage Balance       Monthly Pmt:      Rate:
2nd Mortgage Balance       Monthly Pmt:      Rate:
Annual Income  
My Credit History Is  
Ever filed for bankruptcy?         If so, when:
 Property Information:
Type of Property  
Estimated Property Value         Year Acquired (if applicable) 
Property City & State  
Questions / Comments

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