PRE-QUALIFICATION APPLICATION



APPLICANT #1

FIRST NAME: * LAST NAME: * SS#: *
DATE OF BIRTH: * OR AGE: *
MARRIED UNMARRIED SEPARATED
# OF DEPENDANTS: * (NOT LISTED BY APPLICANT #2) AGES OF DEPENDANTS:
HOME PHONE: * CELL PHONE: * WORK PHONE: *
EMAIL ADDRESS:*
YEARS AT CURRENT ADDRESS: *
OWN RENT LIVE WITH PARENTS
CURRENT ADDRESS: *
CITY: * STATE: * ZIP: *

CURRENT EMPLOYER

EMPLOYER'S NAME: * # OF YEARS EMPLOYED: *
EMPLOYER'S ADDRESS: *
POSITION OR TITLE: * TYPE OF BUSINESS: *
IS THIS JOB:
SEASONAL TEMPORARY BY CONTRACT FROM UNION HALL PART-TIME

PREVIOUS EMPLOYER

EMPLOYER'S NAME: # OF YEARS EMPLOYED:
EMPLOYER'S ADDRESS:
POSITION OR TITLE: TYPE OF BUSINESS:

APPLICANT #2

NAME: LAST NAME: SS#:
DATE OF BIRTH: OR AGE:
MARRIED UNMARRIED SEPARATED
# OF DEPENDANTS: (NOT LISTED BY APPLICANT #1) AGES OF DEPENDANTS:
HOME PHONE: CELL PHONE: WORK PHONE:
YEARS AT CURRENT ADDRESS:
OWN RENT LIVE WITH PARENTS
CURRENT ADDRESS:
CITY: STATE: ZIP:

CURRENT EMPLOYER

EMPLOYER'S NAME: # OF YEARS EMPLOYED:
EMPLOYER'S ADDRESS:
POSITION OR TITLE: TYPE OF BUSINESS:
IS THIS JOB:
SEASONAL TEMPORARY BY CONTRACT FROM UNION HALL PART-TIME

PREVIOUS EMPLOYER

EMPLOYER'S NAME: # OF YEARS EMPLOYED:
EMPLOYER'S ADDRESS:
POSITION OR TITLE: TYPE OF BUSINESS:

GROSS MONTHLY INCOME

  APPLICANT #1 APPLICANT #2
SALARY $ $
OVERTIME $ $
BONUS $ $
COMMISSION $ $
OTHER * $ $
TOTAL * $ $
 
Y-T-D EARNINGS * $ $
LAST YEAR * $ $
 

COMBINED APPLICANT INFORMATION

DEBTS PAYMENT BALANCE
MORTGAGE $ $
REVOLVING CHARGES $ $
INSTALLMENT LOANS $ $
INSTALLMENT LOANS $ $
INSTALLMENT LOANS $ $
INSTALLMENT LOANS $ $
OTHER $ $
ALIMONY / CHILD SUPPORT $ N/A
CHILD CARE $ N/A
TOTAL * $ $

 

CASH ASSETS * $ GIFT FUNDS * $ CASH/GIFT TOTAL * $

 

IF YOU OWN A HOME, WILL IT BE SOLD? * YES NO
 
EXPECTED NET PROCEEDS FROM SALE: $

 

I PLAN TO MAKE A DOWN PAYMENT ON THE PURCHASE PRICE OF: * 20% OR MORE LESS THAN 20%

 

* Notice: Alimony, child support, or separate maintenance income need not be revealed if the borrower(s) does not choose to have it considered for repaying ths loan.

I GIVE PATRIOT FEDERAL BANK PERMISSION TO RUN A CREDIT REPORT FOR THE PURPOSE OF THIS PRE-QUALIFICATION REQUEST. THE UNDERSIGNED AGREE THAT ALL STATEMENTS MADE IN THIS APPLICATION ARE MADE FOR THE PURPOSE OF OBTAINING A CREDIT PRE-QUALIFICATION PRIOR TO ENTERING A CONTRACT TO PURCHASE RESIDENTIAL REAL ESTATE, OCCUPANCY WILL BE AS INDICATED ABOVE; VERIFICATION OR REVERIFICATION OF ANY INFORMATION PROVIDED BY ME MAY BE MADE AT ANY TIME BY THE LENDER, ITS AGENTS, SUCCESSORS, AND ASSIGNS (EITHER DIRECTLY OR INDIRECTLY THROUGH A CREDIT REPORTING AGENCY OR FROM ANY SOURCE STATED ABOVE); THE LENDER, ITS AGENTS, SUCCESSORS, AND ASSIGNS WILL RELY ON THE INFORMATION CONTAINED IN THIS PRE-QUALIFICATION APPLICATION AND I HAVE A CONTINUING OBLIGATION TO AMEND AND/OR SUPPLEMENT THE INFORMATION PROVIDED IF ANY OF THE MATERIAL FACTS WHICH I HAVE REPRESENTED CHANGE. CERTIFICIATION: THE UNDERSIGNED CERTIFY THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT AS OF THE DATE OF MY SIGNATURE AND ACKNOWLEDGE MY UNDERSTANDING THAT ANY INTENTIONAL OR NEGLEGENT MISREPRESENTATION MAY RESULT IN CIVIL LIABILITY AND/OR CRIMINAL PENALTIES INCLUDING, BUT NOT LIMITED TO FINE OR IMPRISONMENT OR BOTH UNDER THE PROVISIONS OF TITLE 18, UNITED STATES CODE, SECTION 1001, ET.SEQ. AND LIABILITY FOR MONETARY DAMAGES TO THE LENDER, ITS AGENTS, INSURERS, SUCCESSORS, ASSIGNS, AND ANY OTHER PERSON WHO MAY SUFFER ANY LOSS DUE TO RELIANCE UPON MISREPRESENTATION MADE BY ME IN CONNECTION WITH THIS PRE-QUALIFICATION APPLICATION.

 

X   X
  APPLICANT * DATE *   APPLICANT DATE

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