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    PREQUALIFY

    Borrower Information:
     
    Borrower (Full Name):
    Date of Birth: (ex. dd/mm/yyyy)
    Soc. Security #:
    Residence Phone #:
    Business Phone #:
    Present Address:
    City:
    State/Province:
    Zip Code/Postal Code:
    E-mail Address
    Years at Present Address:   Rent $ /month
    or Own $
     
    Previous Address:
    City:
    State/Province:
    Zip Code/Postal Code:
    Marital Status: Married
    Separated
    Unmarried (including single, divorced, or widowed)
      
    Occupation:
       (Position & Title)
    # of years:
    Place of Employment:
      (Name & Address)
    Previous Employer:
       (Name & Address)
    Co-Borrower Information:
     
    Co-Borrower (Full Name):
    Date of Birth: (ex. dd/mm/yyyy)
    Soc. Security #:
    Residence Phone #:
    Business Phone #:
    Present Address:
    City:
    State/Province:
    Zip Code/Postal Code:
    E-mail Address
    Years at Present Address:     Rent $  /month
    or   Own $ 
     
    Previous Address:
    City:
    State/Province:
    Zip Code/Postal Code:
     
    Marital Status: Married
    Separated
    Unmarried (including single, divorced, or widowed)
     
    Occupation:
       (Position & Title)
    # of years:
    Place of Employment:
       (Name & Address)
    Previous Employer:
       (Name & Address)
    Gross Annual Income:
     
    Borrower Co-Borrower
    Self-Employed ? Yes    No Yes    No
    Base Salary: $ $
    Overtime: $ $
    Bonuses: $ $
    Commissions: $ $
    Dividends: $ $
    Net Rental Income: $ $
    Other: $ $
     
    Total: $ $
     
    Do You Intend To Occupy This Property ?    Yes     No
    Number of Children:
    Ages:
    Other Dependents:
     
    Assets:
      Other Assets (Specify):
    Checking: $  Bank:
    $  Bank:
    Savings: $  Bank:
    $  Bank:
    Credit Union: $  Bank:
    Stocks: $
    Bonds: $
    Life Insurance: $
     
    Present Residence  (If Owned):
    Market Value: $
    Morg. Value: $
    Lender:
     
     
    Liabilities:
     
    (List outstanding obligations including auto loans, mortgage payments,credit cards,
    personal loans, and all other loans.)
     
    Type Creditor's Name Unpaid Balance Due Date Monthly Payment
    $ $
    $ $
    $ $
    Total:   $ $
     
    Additional Monthly Obligations:
    Alimony:  $
    Child Support:  $
    Child Care:  $
     
    Are There Any Judgements or Lawsuits Present?   Yes    No
    Amount:  $
    Is Any Part of the Down Payment or Settlement Costs
    Being Obtained From a Source Other Than From Assets
    Listed Above?     		  Yes    No
    I hereby give my consent to have my credit report secured
    from any credit reporting agency which you designate.     		  Yes    No




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