Security National Bank

Home Loan Prequalification Request

Thank you for visiting our web site! Please use this form to submit your loan prequalification request electronically or you may contact one of our professional mortgage specialists at (402) 334-9669.

Please complete this form as a “Borrower” or “Co-Borrower,” as applicable.

MORTGAGE TERMS

 Applied For:
 Amount Requested:  $          No. of Months:          Primary Home          Vacation Home         

Borrower

 BORROWER INFORMATION Co-Borrower
Borrower’s Name (include Jr. or Sr. if applicable)
Co-Borrower’s Name (include Jr. or Sr. if applicable)
Social Security Number: Social Security Number:

Home Phone (incl. area code)
Cell Phone (incl. area code)   
Email Address   

Home Phone (incl. area code) 
Cell Phone (incl. area code)
     
Email Address
       
DOB: (MM/DD/YYYY) DOB: (MM/DD/YYYY)
Dependents (not listed by Co-Borrower)
No:        Ages:
Dependents (not listed by Co-Borrower)
No:        Ages:
  Married
 
Separated
 
Unmarried (Include Single, Divorced, Widowed )
Married
Separated
Unmarried (Include Single, Divorced, Widowed )
Present Address (street, city, state, ZIP)
 
Present Address (street, city, state, ZIP)
Own       Rent             No Years : Own       Rent            No Years :
Mailing Address, if different from Present Address
Mailing Address, if different from Present Address

If residing at present address for less than two years, complete the following:    
Former Address (street, city, state, ZIP)
Former Address (street, city, state, ZIP)
 
Own       Rent            No Years: Own       Rent            No Years:

Borrower

 EMPLOYMENT INFORMATION Co-Borrower
Name & Address of Employer:
Name & Address of Employer :
Self Employed              Years on this job: Self Employed              Years on this job: 
Years employed in this line of work/profession  Years employed in this line of work/profession: 
Position/Title/Type of Business
Position/Title/Type of Business
Business Phone (incl. area code)
Business Phone (incl. area code)

If employed in current position for less than two years or if currently employed in more than one position, complete the following:

Name & Address of Employer
 Name & Address of Employer
Self Employed Self Employed
Dates:      From:            To: Dates:      From:           To:  
Gross Monthly Income: $ Gross Monthly Income: $  
Position/Title/Type of Business
Position/Title/Type of Business
Business Phone (incl. area code)
Business Phone (incl. area code)


Name & Address of Employer
 Name & Address of Employer
Self Employed Self Employed
Dates:      From:           To:   Dates:      From:           To:  
Gross Monthly Income: $ Gross Monthly Income: $
Position/Title/Type of Business
Position/Title/Type of Business
Business Phone (incl. area code)
Business Phone (incl. area code)
   

MONTHLY INCOME AND HOUSING EXPENSE INFORMATION
Gross Monthly Income Borrower Co-Borrower Total Monthly
Housing Expense
Present
Base Empl. Income $ $ $ Rent $
Overtime First Mortgage (P&I)
Bonuses Other Financing (P&I)
Commissions Hazard Insurance
Dividends/Interest Real Estate Taxes
Net Rental Income Mortgage Insurance
Other (before, completing, see the notice in "describe other income," below) Homeowner Assn. Dues
Other:
Total $ $ $ Total $

Describe Other Income Notice: Alimony, child support, or separate maintenance income need not be revealed if the Borrower (B) or Co-Borrower (C) does not choose to have it considered for repaying this loan.

B/C  

Monthly Amount

$
 
ASSETS AND LIABILITIES

ASSETS

Cash or Market
Value

List checking and savings accounts below
Name of Financial Institution
$
Name of Financial Institution
$
Name of Financial Institution
$
Name of Financial Institution
$
List stock and bond accounts below
Name of Financial Institution $
Subtotal Liquid Assets $
Real estate owned $
Vested interest in retirement fund $
Net Worth of business(es) owned $
Automobiles owned (make and year)
$
Other Assts (itemize)
$

Total Assets (a)

$
Liabilities and Pledged Assets. List the creditor's name, address and account number for all outstanding debts, including automobile loans, revolving charge accounts, real estate loans, alimony, child support, stock pledges, etc.

LIABILITIES

Monthly Payment & Months Left to Pay Unpaid Balance
Name of Company

Payment/Months
$/

 
$
 
Name of Company

Payment/Months
$/

 
$
 
Name of Company

Payment/Months
$/

 
$
 
Name of Company

Payment/Months
$/

 
$
 
Name of Company

Payment/Months
$/

 
$
 
Name of Company

Payment/Months
$/

 
$
 
Name of Company

Payment/Months
$/

 
$
 
Alimony/Child Support/Separate Maintenance Payments Owed to:

$

 
Job-Related Expense (child care, union dues, etc.)

$

Total Monthly Payments

$

Net Worth
(a minus b)
$ Total Liabilities (b) $
 
Borrower's Signature
Date
Co-Borrower's Signature
Date
 
Please refer my home loan prequalification request to the following loan officer:
No Preference
James Llewellyn MLO # 420062
Ralph Palmer MLO # 420107
Jessica Blake MLO # 892229
This home loan prequalification request is associated with another borrower by the name of:
Name:
 
Please check this box to verify that the above information is correct and is ready to be submitted to the bank.

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