Residential Mortgage Pre-Qualification Form

Name

This field is for validation purposes and should be left unchanged.

Balance Owed on First Mortgage (of home you are refinancing):

Balance Owed on Second Mortgage/ Equity Line (of home you are refinancing):

Amount of Cash You Would Like To Pull Out

Approximate/Desired Purchase Price of Home*

Approximate Cost to Build

Approximate Lot Value

Approximate Purchase Price of Lot

Borrower Information

Date of Birth*

Number Of Dependents (Living in the Home)*

How Did You Hear About Us?*

Employment History

(2-year history needed)

Employer Phone Number*

Employment Start Date*

Length of Employment (Years and Months)

Number of Years in School*

Count 13 for K-12 education

Additional Income Source

Income Verification:

Drop files here or

Max. file size: 300 MB.

W2 employees- Please upload the most recent w2 and paystub for each borrower. Self-Employed Borrowers- Please upload the most recent 2 years of tax returns.

Declaration Questions:

If yes, what is the amount of this money?

Demographic Information of Borrower

The purpose of collecting this information is to help ensure that all applicants are treated fairly and that the housing needs of communities and neighborhoods are being fulfilled. For residential mortgage lending, Federal law requires that we ask applicants for their demographic information (ethnicity, sex, and race) in order to monitor our compliance with equal credit opportunity, fair housing, and home mortgage disclosure laws. You are not required to provide this information but are encouraged to do so. You may select one or more designations for "Ethnicity" and one or more designations for "Race." The law provides that we may not discriminate on the basis of this information, or on whether you choose to provide it. However, if you choose not to provide the information and you have made this application in person, Federal regulations require us to note your ethnicity, sex, and race on the basis of visual observation or surname. The law also provides that we may not discriminate on the basis of age or marital status information you provide in this application. If you do not wish to provide some or all of this information, please check below.

Race:*

Check one or more

Co-Borrower Information

Date of Birth

Co-Borrower Employment History

Employer Phone Number

Employment Start Date

Length of Employment

Number of Years in School

Count 13 for K-12 education

Additional Income Sources

Demographic Information of Co-Borrower

Race:

Check one or more

Declaration Questions:

If yes, what is the amount of this money?

Assets

Checking & Savings Accounts, 401k Plans, IRAs, Stock and Bond

Bank/ Financial Institution Name*

Market Value of real estate owned

Vested in retirement fund

Make/Model vehicle owned

Make/Model Vehicle Owned