The Plainsmen Financial Group, Inc.

Pre-Qualification Form

Please fill in the information below and click on the submit button.
A Plainsmen represenative will contact you within 24 hours.

Borrower

First Name:

Last:

SS#

Address:
City:	State: Zip Code:
Home Phone:	Work Phone: Ext:
Email:
Gross monthly income$

          Co-Borrower

           First Name: Last: SS#

            Home Phone: Work Phone: Ext:

Gross monthly
income$

Property Address

Address:

City: State: Zip Code:

          Loan Detail

                    Requested Amount$   Property Value$
                    Purchase: Available cash for downpayment and closing $
                    Refinance: Amount owed on Current Mortgage $
                                               Additional cash requested                   $

          Monthly Expense
                     Car Payments$ Credit Card Payments$ Other Loan Payments$

                Click below to view our current rates or to use one of the associated calculators.
                Current rates    Payment calculator    Renting Versus Owning
          Additional Comments

By submitting this form you hereby authorize The Plainsmen Financial Group, Inc. to obtain your credit report and or

additional information to determine credit worthiness. This information is strictly confidential.