Pre-Qualify / Quick Application

Purchase  Refinance

2nd Mortgage     Amount 


First Name:          

Spouse First Name:   

Last Name:           


Street Address1:     

Street Address2:     

City/Town:           

State:               

Zip(xxxxx-xxxx):     


       Home Phone (xxx-xxx-xxxx): 

       Work Phone (xxx-xxx-xxxx): 

Spouse Work Phone (xxx-xxx-xxxx): 

        Fax Phone (xxx-xxx-xxxx): 


Email Address:      

Social Security #:  

Spouse SS #:        


Fair Market Value:     

1st Mortgage Balance:  

2nd Mortgage Balance:  


Credit History:

	Excellent  Good  Fair  Poor


If Slow Credit Are Mtgs Current Now? Yes  No

How many times late in last 12 months: 



Self-Employed? Yes  No

Employer:     

How Long:     

Income:       

Income Type:  Salary  Commission


Spouse Self-Employed? Yes  No

Employer:             

How Long:             

Income:               

Income Type:  Salary  Commission


Any Additional Income:   

Own Other Property:      Yes  No

Total Monthly Expenses, less rent: 


 2nd Home

 Rental


Comments


 
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