Loan App

##


use CGI qw/:standard/;

open(DATA, ";
close(DATA);

@data = split(/'::'/, $datatemp);
chomp(@data);

$JSCRIPT=<
	



	
	
END


print "Content-type: text/html\r\n\r\n"; 

print <
	
	$JSCRIPT
	

	Loan App

	

	

	

	



	

	Basic Loan Information



	
		
			Loan Amount 
			Estimated Property Value 
			(or Purchase Price)  
		
	



HTMLBREAK
;

if($data[2] eq "Fixed") {
	$fixed = "checked";
}
if($data[2] eq "ARM") {
	$ARM = "checked";
}

if($data[3] eq "Yes") {
	$EscroYes = "checked";
}

if($data[3] eq "No") {
	$EscroNo = "checked";
}


print <
		
			Type of Loan 
			Fixed
			ARM
			
			
			Escrow
			Yes
			No
			
		
	


HTMLBREAK
;

if ($data[4] eq "Primary Residence") {
	$UsePR = "checked";
}

if ($data[4] eq "Investments") {
	$UseIV = "checked";
}

if ($data[4] eq "Second Home") {
	$UseSH = "checked";
}

print <
		
			Property Use
			
			
		
			
				
			Primary Residence
			Investment
			Second Home
			
			
		
	

	


HTMLBREAK
;

if($data[5] eq "Single Family") {
	$typeSF = "checked";
}
if($data[5] eq "Condo") {
	$typeCD = "checked";
}
if($data[5] eq "Multi Family") {
	$typeMF = "checked"
}

print <
		
			Property Type
			
			
		
		
			
			Single Family
			Condo
			Multi Family
			
			
		
		


	


HTMLBREAK
;


if($data[6] eq "10") {
	$y10 = "checked";
}
if($data[6] eq "15") {
	$y15 = "checked";
}
if($data[6] eq "20") {
	$y20 = "checked";
}
if($data[6] eq "25") {
	$y25 = "checked";
}
if($data[6] eq "30") {
	$y30 = "checked";
}
if($data[6] eq "40") {
	$y40 = "checked";
}
if($data[6] eq "Other") {
	$other = "checked";
	$OL = $data[7];
}


if($data[8] eq "Made an Offer"){
	$HBPMO = "checked";
}
if($data[8] eq "Made an Offer and Accepted") { 
	$HBPOA = "checked";
}
if($data[8] eq "Need Pre-Approval") {
	$HBPNP = "checked";
}



print <
		
			Length of Loan
			Home Buying Process
		
		
			10
			15
			20
			25
			30
			40
			Other 
			
			
			Made an Offer
			Made an Offer and Accepted
			Need Pre-Approval
			
			
		
	
	




	
		
			Property Address
			
		
		
			
			Street 
			
			City 
			State 
			
		

	

	



	
		
			Number of Borrowers 
		
	


	


	

	


	Primary Borrower Information



HTML
;

if($data[16] eq "SR") {
	$SSR = "checked";
}
if($data[16] eq "JR") {
	$SJR = "checked";
}
if($data[16] eq "None") {
	$SNone = "checked";
}
if($data[16] eq "Other") {
	$SOther = "checked";
	$Other = $data[17];
}

if($data[31] eq "Married") {
	$MSM = "checked";
}
if($data[31] eq "Single") {
	$MSS = "checked";
}
if($data[31] eq "Widowed-Divorced") {
	$MSWD = "checked";
}



print <
		
			Primary Borrower
			
		
		
			First Name
			
			
			
			
		
		
			Middle Initial 
			 
			
			
		
		
			Last Name
			
			
			
		
		
			Suffix 
			 
			
			Jr.
					   Sr.
					   None
					   Other 
		
		
			Home Phone Number
			
			
			 
		
		
			Cell Phone Number
			
			
			 
		
		
			Email Address
			
			
			
		
		
			Current Address
		
		
			
			Street 
			City 
			State 
			
		

		
			Mailing Address
		
		
			
			Street 
			City 
			State 
			
		

		
			Social Security Number
			
			
			
		
		
			Birth date
			
			
			Month 
			Day 
			Year 
			
			
		
		
			Marital Status
			
			
			Married
			Single
			Widowed/Divorced
		
	
	

	



	
	


	Co-Borrower Information



HTML
;

if($data[35] eq "SR") {
	$CoSSR = "checked";
}
if($data[35] eq "JR") {
	$CoSJR = "checked";
}
if($data[35] eq "None") {
	$C0SNone = "checked";
}
if($data[35] eq "Other") {
	$CoSOther = "checked";
	$CoOther = $data[36];
}

if($data[50] eq "Married") {
	$CoMSM = "checked";
}
if($data[50] eq "Single") {
	$CoMSS = "checked";
}
if($data[50] eq "Widowed-Divorced") {
	$CoMSWD = "checked";
}




print <
		
			Co-Borrower
			
		
		
			First Name
			
			
			
		
		
			Middle Initial 
			 
			
			
		
		
			Last Name
			
			
			
		
		
			Suffix 
			 
			
			Jr.
					   Sr.
					   None
					   Other 
		
		
			Home Phone Number
			
			
			 
		
		
			Cell Phone Number
			
			
			 
		
		
			Email Address
			
			
			
		
		
			Current Address
		
		
			
			Street 
			City 
			State 
			
		

		
			Mailing Address
		
		
			
			Street 
			City 
			State 
			
		
	
		
			Social Security Number
			
			
			
		
		
			Birth date
			
			
			Month 
			Day 
			Year 
			
			
		
		
			Marital Status
			
			
			Married
			Single
			Widowed/Divorced
		
	
	


HTML
;

if($data[51] eq "Yes") {
	$CHY = "checked";
}
if($data[51] eq "No") {
	$CHN = "checked";
}



print <
		
			Do You agree to Allow Bank of Sullivan to run a Credit History?
		
		
			Yes
		    	No
		
	


	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, but are encouraged to do so.  The law provides that a lender may not discriminate 
	either 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, this lender is required to note the information on the basis of visual observation and surname if you have made this application
	in person.  If you do not wish to furnish the information, please check the box below.  (Lender must review the above material to assure 
	that the disclosures satisfy all requirements to which the lender is subject under applicable state law for the particular type of loan a
	pplied for.)

	


	Do you wish to furnish basic race, ethnicity, and/or gender information?

	

HTML
;

if($data[53] eq "Yes") {
	$POY = "checked";
}
if($data[53] eq "No") {
	$PON = "checked";
}

if($data[54] eq "Yes") {
	$CoOpY = "checked";
}
if($data[54] eq "No") {
	$CoOpN = "checked";
}



print <
		
			Primary Borrower 
			Yes
			No
			
			
			Co-Borrower		
			Yes
			No
			
			
		
	

	
	


HTML
;

if($data[55] eq "HisLat") {
	$POEH = "checked";
}
if($data[55] eq "NotHisLat") {
	$POEN = "checked";
}

if($data[56] eq "HisLat") {
	$CoEH = "checked";
}
if($data[56] eq "NotHisLat") {
	$CoEN = "checked";
}


print <
	
		
			Primary Borrower  
			Hispanic or Latino
			Not Hispanic or Latino
			
			
			Co-Borrower		
			Hispanic or Latino
			Not Hispanic or Latino
			
			
		
	




HTML
;

if($data[57] eq "American Indian or Alaska Native") {
	$AIAN = "checked";
}
if($data[57] eq "Native Hawaiian or Other Pacific Islander") {
	$NHOPI = "checked";
}
if($data[57] eq "Asia") {
	$Asia = "checked";
}
if($data[57] eq "White") {
	$white = "checked";
}
if($data[57] eq "Black or African American") {
	$Black = "checked";
}

if($data[58] eq "American Indian or Alaska Native") {
	$CoAIAN = "checked";
}
if($data[58] eq "Native Hawaiian or Other Pacific Islander") {
	$CoNHOPI = "checked";
}
if($data[58] eq "Asia") {
	$CoAsia = "checked";
}
if($data[58] eq "White") {
	$Cowhite = "checked";
}
if($data[58] eq "Black or African American") {
	$CoBlack = "checked";
}

print <
	
		
			Primary Borrower  
			  
			
			Co-Borrower		
					
			
		
		
			American Indian or Alaska Native
			
			 American Indian or Alaska Native
			
				
		
		
			Native Hawaiian or Other Pacific Islander
			
			 Native Hawaiian or Other Pacific Islander
			
				
		
		
			Asian
			
			 Asian
			
				
		
		
			White
			
			 White
			
				
		
		
			Black or African American
			
			 Black or African American
			
				
		


	

HTML
;

if($data[59] eq "Male") {
	$Male = "checked";
}
if($data[59] eq "Female") {
	$Female = "checked";
}

if($data[60] eq "Male") {
	$CoMale = "checked";
}
if($data[60] eq "Female") {
	$CoFemale = "checked";
}


print <
	


	Gender
	
	
		
			Primary Borrower  
			Male
			Female
			
			
			Co-Borrower		
			Male
			Female
			
			
		
	
	
	



	Additional Information
	
	

	
	

	
	



	
		
			
			
		
	
	

	
HTML
;
Primary Borrower	Co-Borrower
American Indian or Alaska Native	American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander	Native Hawaiian or Other Pacific Islander
Asian	Asian
White	White
Black or African American	Black or African American