Loan  Pre-Qualification Form:

This information allows us to determine which loan program best meets your financial needs.
Also, we will make recommendations on other programs which may allow you to purchase 
a larger home or consolidate more debt. Please be as accurate as possible.

Name       

Address   

City         

State        

Zip Code 

Soc.Sec.#

Spouse's #

Home Tel 

Work Tel 

E-Mail     

Best Time To Call

Are you  interested in:

Purchasing
Refinancing
Investment Property  Loans
Equity Loan
Equity Line of Credit
Commercial Loan

Loan Amount Requested  $

Annual Household  Income  $

Liabilities Information

Liabilities        Min. Monthly  Payment        Approx. Balance

1st  Mortgage  $ $
2nd Mortgage  $ $
Car Payment    $ $
Student Loan    $ $
Credit Card 1   $ $
Credit Card 2   $ $
Credit Card 3   $ $
Credit Card 4   $ $
Loan 1              $ $
Loan 2              $ $
Alimony            $ $
Child Support   $ $
Other Debt       $ $

On a scale of 1 - 10, 10 being perfect, rate your  credit history
1 2 3 4 5 6 7 8 9 10

Bankruptcy? Yes No
If yes, date of discharge

If Purchasing:

Property Address

Purchase Price of the  House You Are  Buying       $

Funds Available for DownPayment/Closing  Costs $

If Own  A  Home, What are You Selling it for        $

If Refinancing/Equity Loan:

Are you consolidating debt?       Yes No

Present Value of Your Property  $

Balance of First Mortgage          $

Rate 

Term

Balance of  Second  Mortgage    $

Rate  

Term 

Additional Comments/Information:

How did you find us?

Comments: