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. Property Information:
Proposed Purchase Price: $   (If Construction - Total Project)

This home will be: (select one)
Primary residence  Second home  Investment property

2. 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

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

4. Title to be held in the name(s) of: 


5. 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.

6. 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 

If renting, please complete the following:
Landlord's First Name:   Last Name:  
Landlord's Phone:

7. 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:

8. 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

9. 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

10. 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.


11. Assets. First list all cars owned, then list primary assets such as bank (checking, savings, IRA), investment, retirement accounts, stock options, real estate.
Automobile Make/Model Year Market Value
$
$
$

Assets: Source: Name of Institution:
$
$
$
$
$
$
$

12. List liabilities that are not paid off on a monthly basis.
Liabilities: Source:
Balance Payment Debt Type Creditor
$ $
$ $
$ $
$ $
$ $
$ $
$ $

13. 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


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

15. 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


16. Are you considering a government loan?
FHA   VA  

Additional Information

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