Please Fill Out This Form To See If You Qualify:

Loan Information
Type of Loan:	New Loan	Refinance
Desired Loan Amount:	$

Borrower's Information
Borrower's Full Name:
Current Address:
City, State and Zip:
How long at current address?
E-Mail Address:
Home Phone Number:
Work Phone Number:
Social Security Number:
Date of Birth:
Borrower's Employment Info
Gross Annual Income:
Place of Employment:
Position:
Length of Employment:
Total Assets:
Total Liabilities:
Co-Borrower's Information
Co-Borrower's Full Name:
Current Address:
City, State and Zip:
Home Phone Number:
Work Phone Number:
Social Security Number:
Date of Birth:
Co-Borrower's Employment Info
Gross Annual Income:
Place of Employment:
Position:
Length of Employment:
Total Assets:
Total Liabilities:
Loans and Credit Cards Total Monthly Credit Card Payments:   Monthly Pmt Total Monthly Loan Payments:   Monthly Pmt.
Contact Info
Best time to call:
Have a REALTOR® contact me:
Comments/Questions?
By selecting "YES" to this radio button, I/WE hereby authorize a consumer credit report to verify credit and other information pertaining to pre-qualification. The information obtained is only to be used for mortgage pre-qualification purposes. SSN and DOB are complete.	Yes No