Mortgage/Home Equity Pre-Qualification Request - First National Bank of Pandora

Required Information

Loan Information

Are you applying as an individual or with a co-applicant?

Individual
Co-Applicant

Loan Type

Purchase
Refinance
Home Equity Line of Credit
Construction Loan

Possible Loan Amount

Applicant Information

First Name Middle Initial Last Name Suffix Social Security Number Birth Date Mother's Maiden Name Current Residency Start Date Home Address City State Zip Code Cell Phone Number Work Phone Number E-mail Address Please do NOT email me important news and updates.

How would you prefer to be contacted?

Home Phone
Cell Phone
Email
Other

Do you currently have accounts with First National Bank?

Applicant Employment

Employed
Not Employed

Employment Start Date Position / Title Gross Monthly Income Name of Employer Employer's Phone Number

Co-Applicant Information

How would you prefer to be contacted?

Home Phone
Cell Phone
Email
Other

Co-Applicant Employment

Employed
Not Employed

Employment Start Date Position / Title Gross Monthly Income Name of Employer Employer's Phone Number

Endorsement

I certify that all information provided by me herein, including attachments (s) is true, correct and complete. I authorize First National Bank to make whatever inquiries about me you deem necessary and appropriate for the purpose of evaluating my credit, including obtaining credit reports and contacting my employer. I also authorize First National Bank to provide credit information about its credit experience with me to other creditors and credit reporting agencies. I authorize the Bank to obtain address information from the Department of Motor Vehicles and waive the address confidentiality requirements of the State Vehicle Code. I agree to provide any further information the Bank might require to process my application.

Applicant's Signature Date Co-Applicant's Signature Date

E-Sign Act Disclosure and Consent

Before proceeding you must confirm that you have read and agree to the terms of the Electronic Signature Act Disclosure available at the link below.

E-Sign Act Disclosure and Consent

I/we confirm that I have read and agree to the terms of the E-SIGN Act Disclosure above. I also agree that the Internet access device(s) I/we will use to receive the related legal disclosures, agreements, online account signature form and the instructions meet(s) the system requirements described in the disclosure presented above; and I/we consent to receiving the related legal disclosures, agreements, online account signature form and the instructions electronically.

Mortgage / Home EquityPre-Qualification Request

Loan Information

Are you applying as an individual or with a co-applicant?

Loan Type

Applicant Information

How would you prefer to be contacted?

Do you currently have accounts with First National Bank?

Applicant Employment

Co-Applicant Information

How would you prefer to be contacted?

Co-Applicant Employment

Endorsement

E-Sign Act Disclosure and Consent

Mortgage / Home Equity
Pre-Qualification Request