This form can be used for purchasing a home or
refinancing your current mortgage.

Pre-Qualification Information: 
Please use the "TAB" key to move between fields.   DO NOT USE the "ENTER" key.

Loan Amount:


Type of Loan:
Purchase Refinance  Second Home Income Property
Commercial Commercial Construction

Type of Financing:
Conventional Fixed Conventional Adjustable Rate  Second Mortgage

Customer Information

Borrower: 

Co-Borrower:  

E-mail: 

Current Street Address: 

City:    State:  AL AK AS AZ CA CO CT DE DC FM FL GA ID IL IN IA KS LA ME MD MA MI MN MS MO MT NE NV NH NM ND OH OK OR PA PR RI SD UT VT VA WA WV WI WY   Zip Code: 

Home Phone: 

Work Phone (include extension if applicable):

Property Information

Purchase Price (Current Value of Property if refinance): 


Cash Down payment (If Purchase):


Property Address: 

Property City:    

Property State:    Property Zip Code: 

Property Type:
Single Family  Condo/Townhouse  Multi Family Apartment Building Mixed Use
Light Industrial Office Building Land Shopping Center Church Mobile Home Park

Will you occupy the property?:
Yes  No

If purchasing, do you have a Realtor® with whom you are working?
Yes  No

Would you like for us to find a Realtor® who specializes in your area?
Yes  No

Credit Information

How would you rate your Credit?  Excellent   Good   Fair   Poor

Borrower Employment Status:                      Co-Borrower Employment Status:
Salaried/Hourly Self Employed        Salaried/Hourly  Self Employed

Borrower Employer                                Co-Borrower Employer                     
                       
Number of years with Company:          Number of years with Company:
                                                          
Borrower Gross Monthly Income:        Co-Borrower Gross Monthly Income:
                                                 
Liquid Assets (Include checking, savings, stocks, mutual funds etc.):
                                                 
Borrower Retirement and 401k:            Co-Borrower Retirement and 401k:
                                                 
Borrower Monthly Auto Payments:      Co-Borrower Monthly Auto Payments:
                                                 
Credit Card (Minimum Mo. Pmt):  Co-Borrower Credit Card (Minimum Mo. Payment):     
                                                 
Other Monthly Debt: (Child Support, Student Loans. Do not include current house payment, rent or utilities)

If Refinancing Answer the following:

If refinancing, enter outstanding balance owed:

What is your Current Interest Rate?:

Type of Current Loan:
Conventional   FHA  VA   Other
Current Monthly Payment (excluding taxes):

Annual Property Taxes:

Do you currently have Mortgage Insurance?:
Yes No
Do you have a Second Mortgage or a line of credit on the Subject Property?:
Yes No
Do you want to keep this loan or consolidate it with the first mortgage? 
Keep  Consolidate

End of Refinancing Questions

General questions:
Any additional information?  Tell us what you'd like to do.  Type in box below:

Thank you
 
This form is not to be considered a formal loan application, but the information gathered here will be used to determine our estimate of the borrower's qualification to obtain a mortgage loan.