HomeDividend℠ — Mortgage Guarantee Application

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Required Federal Disclosures

Please read before completing this application

⚠ EQUAL CREDIT OPPORTUNITY ACT (ECOA) NOTICE — 15 U.S.C. § 1691 The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract), because all or part of the applicant's income derives from any public assistance program, or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning this creditor is the Consumer Financial Protection Bureau (CFPB), 1700 G Street NW, Washington, DC 20552 · (855) 411-2372 · consumerfinance.gov

⚠ FAIR CREDIT REPORTING ACT (FCRA) NOTICE — 15 U.S.C. § 1681 In connection with your application for a mortgage guarantee, HomeDividend will obtain consumer reports and/or investigative consumer reports about you from one or more consumer reporting agencies (CRAs), alternative data providers, and third-party sources. Such reports may include information about your character, general reputation, personal characteristics, and mode of living. You have the right to request that we tell you whether a consumer report was requested and, if so, the name, address, and telephone number of each CRA that provided the report. If we take adverse action based in whole or in part on information obtained from a CRA, you have the right to a free copy of the report from that CRA within 60 days of the adverse action notice, and the right to dispute the accuracy or completeness of any information in the report. CRAs cannot give the specific reasons for adverse action — only we can.

📋 GRAMM-LEACH-BLILEY ACT (GLBA) — PRIVACY NOTICE — 15 U.S.C. § 6801 HomeDividend℠ collects, uses, and shares nonpublic personal information (NPI) about you only as permitted by law and as described in our Privacy Policy. We share NPI with third-party service providers as necessary to process your application, with your consent, or as required by law. We do not sell your personal information. You have the right to opt out of certain sharing of your NPI for marketing purposes. See our full Privacy Policy for details.

📋 HOME MORTGAGE DISCLOSURE ACT (HMDA) — 12 C.F.R. § 1003 We are required by federal law to collect certain information about your ethnicity, race, and sex for purposes of monitoring our compliance with equal credit opportunity, fair housing, and home mortgage disclosure laws. You are not required to provide this information, but you are encouraged to do so. The law provides that we may not discriminate on the basis of this information or on whether you choose to furnish it. If you choose not to provide the information, we are required to note the information on the basis of visual observation or surname.

📋 RESPA SECTION 8 NOTICE — 12 U.S.C. § 2607 The Real Estate Settlement Procedures Act (RESPA) prohibits the payment of kickbacks and referral fees in connection with real estate settlement services. You have the right to select the settlement service providers of your choice. A Good Faith Estimate (or Loan Estimate) of settlement charges will be provided within 3 business days of completed application.

🔒 DATA SECURITY & ELECTRONIC CONSENT This form is secured with 256-bit TLS encryption. By submitting this application electronically, you consent to the use of electronic records and signatures in connection with your application pursuant to the Electronic Signatures in Global and National Commerce Act (E-SIGN Act), 15 U.S.C. § 7001. You may request a paper copy of any record at no charge by contacting us at applications@homedividend.com.

1

Loan Request Information

Tell us about the property and amount you are seeking

Loan Purpose *

Property Type *

Occupancy *

Primary Residence Second Home Investment Property

Loan Amount Requested ($) *

Estimated Property Value ($) *

Down Payment ($) *

Property Address * Street address, City, State, ZIP of the property being purchased/refinanced

State *

ZIP Code *

2

Primary Borrower — Personal Information

Legal name and contact information as it appears on government-issued ID

🔒 Identity Verification Notice The information below will be used to verify your identity through third-party identity verification services. Your Social Security Number (SSN) is required by federal law (Tax Equity and Fiscal Responsibility Act) for tax reporting and identity verification purposes. SSNs are encrypted at rest and in transit and are never stored in plain text.

First Name *

Middle Name

Last Name *

Suffix

Date of Birth *

Social Security Number (SSN) * Format: XXX-XX-XXXX — encrypted immediately on entry

Citizenship Status *

Contact Information

Primary Phone *

Phone Type *

Mobile Home Work

Email Address *

Confirm Email *

Current Residence

Current Street Address *

City *

State *

ZIP Code *

Years at Current Address *

Housing Status *

Renting Own Live w/ Family Other

Monthly Rent / Mortgage Payment ($) Enter $0 if living rent-free with family

Marital Status & Dependents

Marital Status *

Married Separated Unmarried

Number of Dependents

3

Employment & Income

Provide authorization to verify employment through your employer(s)

📋 Employer Verification Authorization By providing your employer information below, you authorize HomeDividend and its authorized agents to contact your current and previous employers to verify your employment status, dates of employment, position, and income. This verification is conducted under the FCRA and Regulation B.

Current Employment

Employment Status *

Employer / Company Name *

Employer Phone *

Employer EIN (optional) Federal Employer Identification Number — helps verify faster

Employer Address *

Your Job Title *

Start Date at Current Employer *

Employment Type *

Full-Time Part-Time Seasonal Contract

Gross Monthly Income ($) * Before taxes and deductions

Net Monthly Income ($) * Take-home pay after taxes and deductions

Additional Income Sources (if applicable)

Additional Income Type

Rental Income Social Security / Disability Alimony / Child Support Pension / Retirement Investment / Dividends Other

Monthly Amount ($) Total additional income per month

⚠ Alimony / Child Support Disclosure You do NOT have to disclose alimony, child support, or separate maintenance income unless you wish to have it considered in evaluating your application (ECOA, 12 C.F.R. § 1002.5(d)(2)).

4

Bank Accounts & Financial Institutions

Authorization to verify assets and review bank statement data

🔒 Bank Account Access Authorization By providing your bank account information below, you authorize HomeDividend and its authorized service providers to access read-only bank statement data (transaction history, balances, and deposit patterns) through secure Open Banking connections (Plaid, MX, or equivalent). This access is used solely to verify income, assess cash flow, and evaluate your application. Your login credentials are never stored. You may revoke access at any time. This authorization is governed by the FCRA and applicable state financial privacy laws.

Primary Checking Account

Bank / Financial Institution Name *

Account Type *

Checking Savings Money Market

ABA Routing Number *

Account Number * Encrypted immediately on entry

Approximate Current Balance ($) *

Months of History Available *

Additional Accounts (optional — add up to 3)

Bank Name

Account Type

Routing Number

Account Number

Balance ($)

5

Alternative Payment History & Service Providers

Authorization to access rent, utility, and recurring bill payment history

💡 Why We Collect This Information HomeDividend℠ uses alternative credit data to evaluate applicants who may not have a traditional FICO score. Consistent on-time payments for rent, utilities, insurance, and phone service are strong predictors of mortgage performance. By providing the information below, you authorize HomeDividend to verify your payment history with each listed provider.

Rental History

Landlord / Property Management Company *

Landlord Phone *

Landlord Email (if available)

Monthly Rent Amount ($) *

Months at Current Address *

Payment Method Used *

Utility Providers

Electric Provider

Account Number (Electric)

Gas Provider

Account Number (Gas)

Water / Sewer Provider

Account Number (Water)

Phone Service

Mobile Carrier

Account Number / Phone Number on File

Account Holder Name (if different)

Months of Service with Current Carrier

Insurance Policies

Auto Insurance Provider

Auto Insurance Policy Number

Renters / Home Insurance Provider

Renters / Home Policy Number

Vehicle / Car Loan (if applicable)

Auto Loan Lender

Account / Loan Number

Monthly Payment ($)

Remaining Balance ($)

6

Co-Borrower Information

Optional — include if co-borrower income will be used for qualification

⚠ ECOA Co-Borrower Notice — 12 C.F.R. § 1002.7 We may NOT require a co-borrower solely because of your marital status. You are required to provide a co-borrower's information only if: (1) the co-borrower will be contractually liable on the account; (2) you are relying on the co-borrower's income; or (3) the property is located in a community property state.

Do you have a co-borrower? *

Yes No

First Name *

Middle Name

Last Name *

Date of Birth *

SSN *

Relationship to Primary Borrower *

Email *

Phone *

Employer Name

Gross Monthly Income ($)

Employment Status

7

Government Monitoring Information

Required by Home Mortgage Disclosure Act (HMDA) — 12 C.F.R. § 1003

📋 HMDA Mandatory Notice 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. The law provides that a lender may not discriminate on the basis of this information, or on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, under federal regulations the lender is required to note the information on the basis of visual observation and surname if you have made this application in person.

Ethnicity

Hispanic or Latino Not Hispanic or Latino I do not wish to provide this information

Race (select all that apply)

American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White I do not wish to provide this information

Sex

Female Male I do not wish to provide this information

8

Declarations, Authorizations & Consents

All items below must be acknowledged before submitting

Declarations

Please answer the following questions about the property and your financial situation. (If applicable, explain in an attached addendum.)

Question	Yes	No
Are there any outstanding judgments against you?
Have you declared bankruptcy within the past 7 years?
Have you had property foreclosed upon in the last 7 years?
Are you a party to a lawsuit?
Are you presently delinquent or in default on a federal debt?
Are you obligated to pay alimony, child support, or separate maintenance?
Is any part of the down payment borrowed?
Are you a U.S. citizen or permanent resident alien?

Required Consents — All Must Be Checked

Electronic Signature

Type Your Full Legal Name as Signature * Typing your name constitutes a legally binding electronic signature under the E-SIGN Act

Date *

Co-Borrower Signature (Full Legal Name)

Your application is encrypted with 256-bit TLS. You will receive a confirmation email within 5 minutes.
Application ID will be assigned upon submission. Processing time: 1–3 business days.
Questions? Call (800) HD-APPLY or email applications@homedividend.com