Mortgage Pre-Qualification Form

Instructions

  1. Use this form to pre-qualify for a mortgage.
  2. Please fill out as much of this form as possible.
  3. When finished click on the send button.

A loan officer will contact you. A phone number is required.

General Information

BorrowerCo-borrower
(If different)
Full Name:
Address:
City:
State:
Zip:
Home Phone:
Work Phone:
Best time to contact:
E-mail:
Social Security #:
Employers:
Employers' Phone Number:
Are you self employed ? Yes No Yes No
Length of Employment:
Gross Monthly Income:
Date of Birth:
My credit history is: excellent
good, but some lates
some credit problems
major credit problems
don't know 		excellent
good, but some lates
some credit problems
major credit problems
don't know

Loan Request

Amount Requested:
Type of loan:

Property Information

(This information needs to be filled out for property that is collateral for the loan)

Street Address:
City:
State:
Zip Code:
Estimated Present Value:
Year Purchased:
Original Price:
Type of Property: Primary Second/Vacation Investment
Purchase Amount:

Loan Information

Mortgage Balances Amount: Held by: Payment:
First:
Second:
Other:

Creditors Amount Owed Monthly Payment Will you pay this off ?
$ $ Yes No
$ $ Yes No
$ $ Yes No
$ $ Yes No

Other monthly debts and information - please describe

By submitting this on-line application, I/We authorize Sample Mortgage Corporation to check such things as my/our credit, business and employment status and histories.

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