Mortgage Loan
Pre-Qualification Request

Borrower Information: Co-Borrower Information:
First Name: First Name:
Middle Initial Middle Initial
Last Name: Last Name:
Address: Address:
City: City:
State:   Zip State:   Zip
How Long? How Long?
Phone #: Phone #:
Social Security#: Social Security#:
Date of Birth: Date of Birth:
Current Employer: Current Employer:
How Long? How Long?
Gross Monthly Income:
(before deductions) 
Gross Monthly Income:
(before deductions)
Work Phone: Work Phone:
Bank Name: Bank Name:
Email Address: Email Address:

Check here if there is a Co-Borrower
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.