How many borrowers on this application?One BorrowerTwo Borrowers

First Name *

Middle Name

Last Name *

Email Address *

Best Contact Number *

Home/Cell Number

Do you rent or own currently?RentOwn

What will you be doing with your primary residence?Selling itRenting itI'm keeping it and purchasing a 2nd homeI'm keeping it and buying a rental property

Current Residence Address *

Unit Number

City *

-Please Select-

Zip Code *

Please Select

Current Employer *

Years at Employer *

Employer Phone Number

Zip Code *

Gross Monthly Income (before taxes)

Position *

How do you get paid?HourlySalaryCommission

Additional IncomeCommissionBonusOvertime

Are you self employed? (this includes 1099 employees)Yes, Self EmployedNo, I receive a W2

Are you obligated to pay court ordered alimony or child support?YesNo

Number of Years in School

Please Select

Click Here to Enter Primary Borrower Declarations

a. Are there any outstanding judgments against you?YesNo

b. Have you been declared bankrupt within the past 7 years?YesNo

c. Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?YesNo

d. Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment?YesNo

e. Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee? If "Yes," give details as described in the preceding question.YesNo

Provide details, including date, name, and address of Lender, FHA or VA case number, if any, and reasons for the action described in "e" above.

f. Are you obligated to pay alimony, child support, or separate maintenance?YesNo

Provide details, including date, name, and address of Lender, FHA or VA case number, if any, and reasons for the action described in "f" above.

g. Is any part of the down payment borrowed?YesNo

h. Are you a co-maker or endorser on a note?YesNo

i. Are you a U. S. citizen?YesNo

j. Are you a permanent resident alien?YesNo

Account #1CheckingSavingsMoney Market

Avg monthy balance

Retirement Account Total Vested Amount

Account #2CheckingSavingsMoney Market

Avg monthy balance

CD/ Other Total Amount

Account #3CheckingSavingsMoney Market

Avg monthy balance

What is the maximum monthly mortgage payment that you are comfortable with? (This includes Property Taxes and Mortagage Insurance) This will help us determine your maximum pre-approved price range.

Please feel free to list any additional comments below:

Realtor's Name

Realtor's Phone Number

Client Approval: By completing my name below and submitting this form, I authorize OUR COMPANY to order a copy of my credit report to use in conjunction with this pre-qualification worksheet. Please type in your full name.

Client #2 Approval: By completing my name below and submitting this form, I authorize OUR COMPANY to order a copy of my credit report to use in conjunction with this pre-qualification worksheet. Please type in your full name.

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