Mortgage Loan Pre-Qualification Request

Loan Information

Are you applying as an individual or with a co-borrower? Individual Co-Borrower

Borrower Information

First Name Middle Initial Last Name Home Address City State Zip Code How Long at Current Address? Phone Number Social Security Number Birth Date (mm/dd/yyyy) Current Employer How Long at Current Employer? Gross Monthly Income (before deductions) E-mail Address Please do NOT email me important news and updates.

Co-Borrower Information

Communication

Have you already spoken with one of our Loan Officers? Yes No

If so, what is the name of the Loan Officer?

Certification

I/we certify that all information contained above and in exhibits submitted to the lender are true and complete to the best knowledge and belief of the applicant(s) and are submitted for the purpose of pre-qualification for a mortgage loan. I/we understand that you will retain this pre-qualification whether or not it is approved. You are approved to check my /our credit and employment plus answer any questions regarding my/our credit experience with you.

This request is intended for pre-qualification purposes only and is not an application.