If you are a third party filling out this form, BSA needs this information to make contact with the client.
Borrower Name
Term of Loan
Borrower Phone
In order to fill in loan documents accurately we will need to identify in the same way the loan documents identify the property.
Property Address
Property City
Property State Select One Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming
Property Zip Code
Lender Name
In order to give you credit for the work you perform or to ask you specific follow up questions we will need to know how to contact you
Lender Phone
Lender Email
Loan Officer Name
Loan Officer Phone
Loan Officer Email
We would like some background information to aid in the analysis of the potential energy savings.
Year Built
Livable Square Feet
Public Utility
Propane Select One Yes No
Fuel Oil Select One Yes No
Wood Select One Yes Partial / Sometimes No
Client must have 12 months of utility bills available. If they do not have they can call or go on-line and receive directly from their utility company. If they would like BSA to obtain from their utility company they must sign a release form with the proper information.
Last 12 Months of Utility Bills Select One Yes No
Is Power Available Select One Yes No
Name of person and/or firm to contact to gain access to the property.
Contact for Entry
Contact Entry Phone Number
Name of listing agency for purchase please leave blank for Refinance.
Real Estate Agency
Real Estate Agent
Real Estate Phone
Real Estate Email
Appraisal Status Select One Ordered Not Ordered Completed
Rules for mortgages vary by the type of loan being created please share if this is a Purchase or Refinance.
Finance Type Select One Mortgage Refinance
Loan Type Select One Conv FHA VA
Note Rate
Note Rate Terms Select One Term Fixed ARM
Appraised Value
Loan Amount
PITI
We will need to set up instruction for the escrow with the title company please supply contact information.
Title Company Name
Title Company Address
Title Company City
Title Company State Select One Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming
Title Company Zip
Title Company Phone Number
Title Company Escrow Officer
Title Company Escrow Number
In order to meet your deadlines we will need to know how soon the loan is anticipated to close.
Expected Date of Loan Closing
Place of Closing
This is the form to begin the process of applying for Energy Efficient Financing. In most cases you will want to have done the Energy Audit before hand to find out what improvements are needed and how much you could be saving on your monthly household cash-flow. Please authorize an Energy Audit being done before you fill out this form if one has not been done yet.
Upon the loan officer submitting your application for a home energy audit the homeowner needs to fill out the Energy Efficient Finance Application and all boxes that are marked with a red *. The Energy Efficient Finance Application can be filled out on line using this form or printed and mailed or faxed to the information below. Again there is no obligation or cost to the homeowner for filling out this application however it is required to provide a preliminary analysis of the energy efficiency of your home and determine if you would qualify for a free home energy audit. So apply now for a potential free home energy audit of your home and get your home a physical evaluation for safety, comfort and energy efficiency.
Also, please sign and fax us the utility release form to give BSA permission to research your cost savings.