Borrower
First Name                                               Middle             Last Name
 
      SS Number         --

 Co Borrower
First Name                                               Middle Initial            Last Name
 
      SS Number         --

Please contact   borrower co-borrower      at the following

Email                  

Phone Day        

Phone Evening 

Present Address

Street 

City     

State   Alabama Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island Sourth Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip

Type of Mortgage  Conventional FHA VA Adjustable     Purpose of Loan   Purchase Refinance Refinance for Cash Out Construction Construction-Permanent

Property will be Primary Residence Secondary Residence Investment  

Loan Amount          Property Value

Income 
Borrower                                                            CO-Borrower 
Gross Monthly Income                           Gross Monthly Income  

Assets
Checking                     
Savings (CD & MM) 
Stocks & Bonds         
401K (or equivalent)  
 

Debts
Mortgage Payment               
Car Payment                           
Total Credit Card Balances  
Student Loans                       
Alimony or Child Support   
Misc.                                       

   Thank you for completing this Pre-Qualification Form.  A representative from
   MORTGAGE will be contacting you within 24 hours.