Pre-Qualify Form

Please complete this form and click on the submit button. If you have any other questions, please contact your Loan Officer.


Section 1 - Borrower Information
Borrower: Co-Borrower:
*First Name: First Name:
*Last Name: Last Name:
*Current Address 1: Current Address 1 (if
different from Borrower):
Current Address 2: Current Address 2:
*City: City:
*State,Zip: , State,Zip: ,
*Daytime Phone: Daytime Phone:
Cell / Pager: Cell / Pager:
*Email Address: Email Address:
SSN: SSN:
Date of Birth: Date of Birth:
(Please provide your Social Security Number(s) if you wish us to provide a credit check at this time.)

Section 2 - Loan Information
*Loan Purpose *Occupancy *Type
Property address for the loan (if different from your address above):   
*City, State and Zip:    ,    , 
Estimated Value (of property to be financed): $
Amount you wish to borrow: $
If you're applying for a cash-out refinance, how much cash is requested?: $
If you're refinancing, what is the current loan balance: $
Any specific loan program you are interested in?  

Section 3 - Income
Borrower: Co-Borrower:
Employment Type   Employment Type  
Gross Monthly Income from primary employment: $ Gross Monthly Income from primary employment: $
Other Income: $ Other Income: $
Other Income: $ Other Income: $

Section 4 - Assets
Approximate balance in each account
Checking: $
Savings: $
Retirement or 401(k): $
Stock: $
*Where will the funds to close come from? (Check all that apply)
  Checking or Savings
  401(k) or Stock
  Gift

Section 5 - Debt
Monthly Debt
Car monthly payment: $ Credit card monthly payment: $
2nd car monthly payment: $ 2nd credit card monthly payment: $
Student loan monthly payment: $ 3rd credit card monthly payment: $
Other Debt: $

   
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