Complete this form to be pre-qualified for a loan.
(Items in red are required.)

	BORROWER		CO-BORROWER
Name		Name
Address		Address
City/State/Zip		City/State/Zip
Since		Since
Soc.Sec.#		Soc.Sec.#
Hm Phone		Hm Phone
Wk Phone		Wk Phone
D.O.B.		D.O.B.
eMail		eMail
Mo.Income		Mo.Income
Mo.Payments		Mo.Payments
$$ In Bank		$$ In Bank

I/We are applying for a prequalification for a mortgage loan.  As part of the process, the above information may be verified and a credit report may be pulled.  I/We authorize the verification and accessing of this information.

Accept    Decline

Enter notes or questions in the space provided below.
Please include best contact method & time.

This information is not intended  as an extension of Consumer Credit as defined by Title 12, Code of Federal Regulations, Section 226.2. Not a Loan  Commitment.