Pre-Qualification Form

Prequalification:
Personal Information
First Name:*
Last Name:*
Email:*
Referral Name:
Home Phone:*
Cell Phone:
Work Phone:
Marital Status:
Are you a U.S. Citizen?:
Date of Birth: (mm/dd/yyyy)
Social Security Number:*
Credit Check Authorization:
Years of School:
Number of Dependents:
Dependents Age(s): Separate ages by commas
Loan Officer:
Current Address
Street Address:
City:
State:
Zip:
Years at this Address:
Rent or Own:
Purpose of Loan:
Property Usage:
Purchase Price:*
Loan Amount:* $
Monthly Income
Base Income:* $
Bonuses: $
Commission: $
Other Income: $
Employer Name:*
Employer Address:*
Years Employed:*
Title:*

Assets
Checking: $
Savings: $
Retirement Funds: $
Mutual Funds: $
Other: $
Co-Borrower:
Do you have a co-borrower? Yes   No
First Name:
Last Name:
Email:
Home Phone:
Cell Phone:
Work Phone:
Are you a U.S. Citizen?:
Date of Birth: (mm/dd/yyyy)
Social Security Number:
Credit Check Authorization:
Monthly Income
Base Income: $
Bonuses: $
Commission: $
Other Income: $
Employer Name:
Employer Address:
Years Employed:
Title:

Assets
Checking: $
Savings: $
Retirement Funds: $
Mutual Funds: $
Other: $
Other Comments:
Credit Authorization
By clicking "I agree to hereby grant permission for us to obtain all information deemed necessary to process your mortgage loan application. This information includes, but is not limited to, your past and present employment status, your deposit accounts, your past and present consumer credit record, your mortgage record and/or your rental record.
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Electronic Disclosure Authorization
By applying for a loan online, you agreee to accept all applicable disclosures associated with this transaction in an electronic form, including disclosures required by the Truth in Lending Act, Real Estate Settlement procedures Act and Equal Credit Opportunity Act. Paper copies will be provided for certain real estate related transactions after your loan application is received.
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Patriot Act
To help the government fight the funding of terrorism and money laundering activities, Federal Law required all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: As part of applying for your mortgage loan, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.
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* Required Field