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  3. CFPB's Regulation Z
  4. APPENDIX H to Part 1026
  5. H-16
6-6015.1

H-16—Mortgage Sample

You are not required to complete this agreement merely because you have received these disclosures or have signed a loan application.
If you obtain this loan, the lender will have a mortgage on your home.
YOU COULD LOSE YOUR HOME, AND ANY MONEY YOU HAVE PUT INTO IT, IF YOU DO NOT MEET YOUR OBLIGATIONS UNDER THE LOAN.
You are borrowing $ 
(optional credit insurance is □  is not □  included in this amount).
The annual percentage rate on your loan will be
%.
Your regular [frequency]  payment will be $      .
[At the end of your loan, you will still owe us $[balloon amount] .]
[Your interest rate may increase. Increases in the interest rate could increase your payment. The highest amount your payment could increase is to $ 
.]
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