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

Monthly Income Income Source

Co-Borrower Information

How would you prefer to be contacted?

Home Phone
Work Phone
Email
Other
Other Preference

Monthly Income Income Source

Endorsement

I certify that all information provided by me herein, including attachment(s) is true, correct and complete. I authorize Logan Bank and Trust 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 agree to provide any further information Logan Bank and Trust might require to process my application.

Borrower's Signature Date Co-Borrower's Signature Date