Mortgage / Purchase Pre-Qualification Request

Required Information

Loan Information

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

Borrower Information

Do you currently Rent or Own?

*If you own your current home, it will be Sold or Rented, prior to purchasing new property?

How would you prefer to be contacted?

Borrower Employment

Purchase Details

Is down payment percentage less than 20%?

Current Assets

Please list all Real Estate Owned: (if applicable)

Real Estate Owned #1

Real Estate Owned #2

Real Estate Owned #3

Source of Downpayment and Other Deposits/Assets

Other Income to be Used in Prequalification

Co-Borrower Information

How would you prefer to be contacted?

Co-Borrower Employment


I certify that all information provided by me herein, including attachments (s) is true, correct and complete. I authorize XXXXXX 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 XXXXXX 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 Section XXXX.XX of the State Vehicle Code. I agree to provide any further information the Bank might require to process my application.