Pre-Qualification Worksheet

IMPORTANT INFORMATION ABOUT PROCEDURES WHEN APPLYING
FOR A REAL ESTATE RELATED LOAN

To help the government fight the funding of terrorism and money-laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who applies for credit.

What this means to you: when you apply for a loan, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see and make a copy of your valid driver's license or other identifying documents prior to closing on your loan.

How did you hear about us?
Referred by:

1. Down Payment: $ or % (specify either dollar amount or percentage of purchase price)
Down Payment will come from:  
(checking, savings, investment account, sale of stock, sale of home, 401K loan, gift) Please specify

2. Term of Mortgage Requested:   years
Type: (select one)
ARM  Fixed  Undecided

3. Borrower Information:
Borrower: Married   Unmarried   Separated
First:   Middle:   Last:
Social Security Number:   Date of Birth (mm/dd/yyyy):
Years of School:   Number of Dependents:   Ages:
Use comma to separate dependents ages.

Is this form being completed jointly or not jointly?
Co-Borrower: Married   Unmarried   Separated
First:   Middle:   Last:
Social Security Number:   Date of Birth (mm/dd/yyyy):
Years of School:   Number of Dependents:   Ages:
NOTE for Co-Borrower: Only list dependents NOT listed by borrower.

4. Borrower's Home Address:
Street:
City:   State:   Zip:

Do you: Own   Rent  Live Rent Free 
# years at this residence 
Current monthly housing payment: $
Do you intend to sell current home? Yes   No
Current home listed for sale? Yes   No
Estimated Market Value: $
Under Contract? Yes   No

If less than a 2 year history at current address, please fill out information about previous address:
Street:
City:   State:   Zip:

Did you: Own   Rent  Live Rent Free 
# years at this residence 


5. Contact Information

Borrower
 Co-Borrower
Daytime Phone:
Home Phone:
Work Phone:
Fax:
Email:
Cellular Phone:
Daytime Phone:
Home Phone:
Work Phone:
Fax:
Email:
Cellular Phone:

6. Employer Information:   (2 year history)
Employer Name:
Street Address:
City:   State:   Zip Code:
Employer Phone:
Job Title:  
years, months with current employer.
# Years at this type of work:
Corporate Relocation: Yes   No  
Are you self-employed? Yes   No  

If less than 2 year history at current job, fill out for previous employer
Employer Name:
Street Address:
City:   State:   Zip Code:
Employer Phone:
Employed from (mm/dd/yyyy) to

7. Co-Borrower's Employer Information:   (2 year history)
Employer Name:
Street Address:
City:   State:   Zip Code:
Employer Phone:
Job Title:  
years, months with current employer.
# Years at this type of work:
Corporate Relocation: Yes   No  
Are you self-employed? Yes   No  

If less than 2 year history at current job, fill out for previous employer
Employer Name:
Street Address:
City:   State:   Zip Code:
Employer Phone:
Employed from (mm/dd/yyyy) to

8. List monthly income and sources of income.

Gross Monthly Income Borrower Co-Borrower
Base Empl Income $ $
Overtime $ $
Bonuses $ $
Commissions $ $
Dividends/Interest $ $
Net Rental Income $ $
$ $
$ $
Totals: $ $
NOTICE: Alimony, child support, or separate maintenance income need not be revealed if it is not to be considered for repaying this loan.

9. List liabilities that are not paid off on a monthly basis.
Liabilities: Source:
BalancePaymentDebt Type Creditor
$ $
$ $
$ $
$ $
$ $
$ $
$ $

10. Are there any judgments, lawsuits, bankruptcy (last 10 years), foreclosures, alimony, child support, or indirect credit obligations (guarantees or co-signing) we should be aware of?
Yes   No       If Yes, please describe


11. Are the borrowers U.S. Citizens?
Yes   No      If No, Visa Type:

12. Do you own 25% or more of any Corporation or Partnership, or derive 25% or more of your income from commissions?
Yes   No      If Yes, please describe


13. Are you considering a government loan?
FHA   VA  

Additional Information

NOTE: Please print a copy for your file before submitting.

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