Mortgage / Home Equity Pre-Qualification Request

Required Information

Loan Information

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

Borrower 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 Home 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 Work Phone Email Other

Other Preference

Borrower Employment

Borrower Employment Status Employed Not Employed

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

Co-Borrower Information

How would you prefer to be contacted? Home Phone Work Phone Email Other

Other Preference

Co-Borrower Employment

Borrower Employment Status 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 Bank Name 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 Bank Name 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.

Borrower's Signature Date

Co-Borrower's Signature Date