Name (First Last):
Co Borrower (First Last):
Social Security #(optional)* :
Co Borrowers SS #(optional)* :
Phone Number :
Work Number :
E-Mail Address :
Street Address :
Apartment :
City :
State :
Zip :
Who refered you to us :
Price Range :
I am working with a REALTOR®
Please refer me to
a REALTOR®
I am buying direct from the
seller
I am buying direct from the
builder
If you are working with a REALTOR®
REALTOR® :
Firm :
Type of Inquiry :
Mail prequalification letter to REALTOR® ?
Purchase
New Construction
Refinance
Are you eligible for a V.A. Loan
No
Yes
maybe
Yes
No
Yes, but mail
letter only (no data)
Cash Assets
Location
Balance
Checking
Saving
Money market
Stocks
Bonds
Tax shelter annuities
Annuities
401-K
403-B
Certif. of deposit
Proceeds (house sale)
Inheritance
Divorce settlement
Property
Savings bonds
Life ins. cash value
Insurance settlements
Cash on hand
Gift
IRAs
Retirement Lump Sums
Income Tax Refund
Bonuses
Checking
Saving
Money market
Stocks
Bonds
Tax shelter annuities
Annuities
401-K
403-B
Certif. of deposit
Proceeds (house sale)
Inheritance
Divorce settlement
Property
Savings bonds
Life ins. cash value
Insurance settlements
Cash on hand
Gift
IRAs
Retirement Lump Sums
Income Tax Refund
Bonuses
Checking
Saving
Money market
Stocks
Bonds
Tax shelter annuities
Annuities
401-K
403-B
Certif. of deposit
Proceeds (house sale)
Inheritance
Divorce settlement
Property
Savings bonds
Life ins. cash value
Insurance settlements
Cash on hand
Gift
IRAs
Retirement Lump Sums
Income Tax Refund
Bonuses
Checking
Saving
Money market
Stocks
Bonds
Tax shelter annuities
Annuities
401-K
403-B
Certif. of deposit
Proceeds (house sale)
Inheritance
Divorce settlement
Property
Savings bonds
Life ins. cash value
Insurance settlements
Cash on hand
Gift
IRAs
Retirement Lump Sums
Income Tax Refund
Bonuses
Checking
Saving
Money market
Stocks
Bonds
Tax shelter annuities
Annuities
401-K
403-B
Certif. of deposit
Proceeds (house sale)
Inheritance
Divorce settlement
Property
Savings bonds
Life ins. cash value
Insurance settlements
Cash on hand
Gift
IRAs
Retirement Lump Sums
Income Tax Refund
Bonuses
Checking
Saving
Money market
Stocks
Bonds
Tax shelter annuities
Annuities
401-K
403-B
Certif. of deposit
Proceeds (house sale)
Inheritance
Divorce settlement
Property
Savings bonds
Life ins. cash value
Insurance settlements
Cash on hand
Gift
IRAs
Retirement Lump Sums
Income Tax Refund
Bonuses
Gross Income per Month
Source
Amount/Month
Salary
Commision
Bonus
Over-Time
Rental income
Social Security
Alimony
Disability
Child support
Retirement
Dividends
Interest
Second job income
Royalties
Summer research
Self employment
NationalGuard
Trust/inheritance
Tips if reported
Rec. capital gains
Notes rec. income
Welfare if recuring
Salary
Commision
Bonus
Over-Time
Rental income
Social Security
Alimony
Disability
Child support
Retirement
Dividends
Interest
Second job income
Royalties
Summer research
Self employment
NationalGuard
Trust/inheritance
Tips if reported
Rec. capital gains
Notes rec. income
Welfare if recuring
Salary
Commision
Bonus
Over-Time
Rental income
Social Security
Alimony
Disability
Child support
Retirement
Dividends
Interest
Second job income
Royalties
Summer research
Self employment
NationalGuard
Trust/inheritance
Tips if reported
Rec. capital gains
Notes rec. income
Welfare if recuring
Salary
Commision
Bonus
Over-Time
Rental income
Social Security
Alimony
Disability
Child support
Retirement
Dividends
Interest
Second job income
Royalties
Summer research
Self employment
NationalGuard
Trust/inheritance
Tips if reported
Rec. capital gains
Notes rec. income
Welfare if recuring
Salary
Commision
Bonus
Over-Time
Rental income
Social Security
Alimony
Disability
Child support
Retirement
Dividends
Interest
Second job income
Royalties
Summer research
Self employment
NationalGuard
Trust/inheritance
Tips if reported
Rec. capital gains
Notes rec. income
Welfare if recuring
Salary
Commision
Bonus
Over-Time
Rental income
Social Security
Alimony
Disability
Child support
Retirement
Dividends
Interest
Second job income
Royalties
Summer research
Self employment
NationalGuard
Trust/inheritance
Tips if reported
Rec. capital gains
Notes rec. income
Welfare if recuring
Loans and Payments
Creditor
Payment
Months Left
Car payments
Installment loans
Personal loans
Credit cards
Student Loans
Mortgage loans
Real estate loans
Alimony
Child support
Loans against Life Ins.
Retirement accounts
Loans cosigned on
Equity lines
Car payments
Installment loans
Personal loans
Credit cards
Student Loans
Mortgage loans
Real estate loans
Alimony
Child support
Loans against Life Ins.
Retirement accounts
Loans cosigned on
Equity lines
Car payments
Installment loans
Personal loans
Credit cards
Student Loans
Mortgage loans
Real estate loans
Alimony
Child support
Loans against Life Ins.
Retirement accounts
Loans cosigned on
Equity lines
Car payments
Installment loans
Personal loans
Credit cards
Student Loans
Mortgage loans
Real estate loans
Alimony
Child support
Loans against Life Ins.
Retirement accounts
Loans cosigned on
Equity lines
Car payments
Installment loans
Personal loans
Credit cards
Student Loans
Mortgage loans
Real estate loans
Alimony
Child support
Loans against Life Ins.
Retirement accounts
Loans cosigned on
Equity lines
Car payments
Installment loans
Personal loans
Credit cards
Student Loans
Mortgage loans
Real estate loans
Alimony
Child support
Loans against Life Ins.
Retirement accounts
Loans cosigned on
Equity lines
Car payments
Installment loans
Personal loans
Credit cards
Student Loans
Mortgage loans
Real estate loans
Alimony
Child support
Loans against Life Ins.
Retirement accounts
Loans cosigned on
Equity lines
Car payments
Installment loans
Personal loans
Credit cards
Student Loans
Mortgage loans
Real estate loans
Alimony
Child support
Loans against Life Ins.
Retirement accounts
Loans cosigned on
Equity lines
Car payments
Installment loans
Personal loans
Credit cards
Student Loans
Mortgage loans
Real estate loans
Alimony
Child support
Loans against Life Ins.
Retirement accounts
Loans cosigned on
Equity lines
Car payments
Installment loans
Personal loans
Credit cards
Student Loans
Student Loans
Mortgage loans
Real estate loans
Alimony
Child support
Loans against Life Ins.
Retirement accounts
Loans cosigned on
Equity lines
Car payments
Installment loans
Personal loans
Credit cards
Student Loans
Mortgage loans
Real estate loans
Alimony
Child support
Loans against Life Ins.
Retirement accounts
Loans cosigned on
Equity lines
Car payments
Installment loans
Personal loans
Credit cards
Student Loans
Mortgage loans
Real estate loans
Alimony
Child support
Loans against Life Ins.
Retirement accounts
Loans cosigned on
Equity lines
Additional information that may be helpful in qualifying:
Borrowers Date of Birth:
Co Borrowers Date of Birth:
Years of College - Borrower:
Years of College - Co-borrower:
Ages of Dependents:
Make and Model Year of Cars Owned:
Make
Model Year
Car 1:
Car 2:
Car 3:
If you have any special circumstances and/or other concerns, please make note of them
here. David will address these items when he calls you to go over your prequalification
form.