Pre-Quilification Form

All Boxes with a * are required.

This is not an application. Please call 599-5086 if you need an application sent. To contact us you can use the numbers to the right and we’ll connect you with our staff right now or visit our “Contact Us” page.

Tell us about yourself
Applicant Name * Co-Applicant Name
Home Phone * Home Phone
Work/Cell PHone Work/Cell Phone
Email Address * Email Address
Employment and Income Information
Self Employed? Yes Self Employed? Yes
Employer Employer
How long? (Yrs/Mths) How long? (Yrs/Mths)
Monthy Gross Income Monthly Gorss Income
Overtime Overtime
Bonuses Bonuses
Commissions Commissions
Retirement/Other Retirement/Other
Assets Information
Checking Checking
Savings Savings
CD's/Stocks/Bonds CD's/Stocks/Bonds
Combined Monthly Liabilities
Type Monthly Payment Unpaid Balance
Credit Cards  
Auto Loans  
Other Laons  
Child Support/Maintenance  
House Information
Address Number of Units
City Occupancy Type
State Estate held
Zipcode Property Value
Current Mortgage information
Current Mortgage Type
Is there a pre-payment penalty?
What is your interest rate?
Current ballance on your mortgage
New Mortgage Information
Fixed or ARM?
What loan term you are looking for?
What type of loan?
If you selected "Refinance", what is the purpose?
If you selected "Other" please explain

What is the desired loan amount?
What is the estimated purchase price?
Additional Comments
Please list any additional comments here.