Prequalification Form
Borrower
First Name: Last: SS#
Address:
City: State: Zip Code:
Home Phone: Work Phone: Ext:
Co-Borrower
First Name: Last: SS#
Home Phone: Work Phone: Ext:
Property Address
Address:
City: State: Zip Code:
Loan Detail
Amount$ Purpose: Property Value$

Occupancy: Term(in months): Down Payment%

Base Income$ Other Income$

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

Additional Comments
By submitting this form you hereby authorize this company to obtain your credit report and/or additional information to determine credit worthiness. This information is strictly confidential.

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