Mortgage Pre-Qualification Request

Required Information

Loan Information

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

Check all that apply

Borrower Information

Marital Status

How would you prefer to be contacted?

Borrower Employment

Have you worked here for less than two years? (Yes, if unemployed)

Do you currently own any other properties?

Co-Borrower Information

Marital Status

How would you prefer to be contacted?

Co-Borrower Employment

Have you worked here for less than two years? (Yes, if unemployed)

Do you currently own any other properties?

Endorsement

I certify that all information provided by me herein, including attachment(s) is true, correct and complete. I authorize Mid Penn 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 Mid Penn 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.