PREQUALIFICATION    FORM

BORROWER'S INFORMATION

Your name:   First   Middle Initial   Last 

Current Address:   

Years at current address:   If less than 2 Years at your current address please give previous.

 Previous Address:   

Social Security #:     Date of Birth:  (MM/DD/YY)     Age:       

Home Phone:          Work Phone:  

Cell Phone:

Employment status? Self-Employed Employed Retired Disabled How long at present employer?

Name, Address of present employer?

What is your occupation?

If less than 2 years at present employment, Name & Address of previous employer?  

What was your occupation?   How long employed?

CO-BORROWER'S INFORMATION

Your name:   First   Middle Initial   Last 

Current Address:   

Years at current address:   If less than 2 Years at your current address please give previous.

 Previous Address:   

Social Security #:     Date of Birth:  (MM/DD/YY)     Age:       

Home Phone:         Work Phone:    

Cell Phone:

Employment status? Self-Employed Employed Retired Disabled How long at present employer?

Name, Address of present employer?

What is your occupation?

If less than 2 years at present employment, Name & Address of previous employer?  

What was your occupation?   How long employed?

INCOME AND DEBT INFORMATION 

GROSS VERIFIABLE MONTHLY INCOME:

Borrower $  Co-Borrower $  

Total monthly income before taxes? $

RECURRING DEBTS:

Type of debts are Car Loans, Installment Loans, Credit Card Monthly Payments

Type/Name $

Type/Name $

Type/Name $

Type/Name $

Type/Name $

Total monthly debt: $

GENERAL INFORMATION

How would you rate your credit? Excellent Good Good - Some Lates Some Credit Problems Major Credit Problems Prior Bankruptcys

Are you a first time home buyer (No property in your name for the last 3 yrs)? No Yes

Ever file for bankruptcy? No Yes If yes, how long ago?   Any tax liens? No Yes

Best time to contact?  Day (Hour)      and Evening? (Hour)

E-mail address?
         Authorization to Pull Credit Reports No Yes