Borrower Information

Include a Co-Borrower

Borrower's Name:

Title/*First/Middle/*Last:
///

Social Security Number and Age:

SSN# Age Date of Birth:

What are your telephone numbers?

*Home: *Work:

Borrower's current address:

Occupancy: Years: Months: Rent Own
*Street:

*City, *State *Zip:
,

Borrower's former address:

[if less than 2 yrs at current address]
Occupancy: Years: Months:Rent Own
Street:

City, State Zip:
,

Co-Borrower Information

Co-Borrowers Name:

Title/*First/Middle/*Last:
///

Co-Borrower's SS Number and Age:

SSN# Age Date of Birth:

What are your telephone numbers?

Home: Work:

Co-Borrower's current address:

Occupancy: Years: Months: Rent Own
Street:

City, State Zip:
,

Co-Borrower's former address:

[if less than 2 yrs at current address]
Occupancy: Years: Months: Rent Own
Street:

City, State Zip:
,

Step 2. Tell us about the property and loan you want.

Desired Mortgage Information

Type of Mortgage Loan:
Program Type:
Purpose of this loan:
If you selected "Refinance", what is the purpose?
If you selected "Other", please explain:

Property Details

Appraisal value of the property: $
Desired loan amount: $
If purchase, what is the estimated purchase price? $
Estimated down payment amount: $
If refinance, what is the total owed on home? $
If refinance or construction, what is the property value? $
Length of your requested loan:

Step 3. Tell us about your employment.

Borrower

Current Employer:

*Self Employed? YES NO
Employer:
*How Long: Yrs Mths
Monthly Income: $
Overtime: $
Bonuses: $
Commissions: $
Other: $

Previous Employer:

Self Employed? YES NO
Employer:
How Long? From: To:
*Monthly Income: $

Co-Borrower

Current Employer:

Self Employed? YES NO
Employer:
How Long: Yrs Mths
Monthly Income: $
Overtime: $
Bonuses: $
Commissions: $
Other: $

Previous Employer:

Self Employed? YES NO
Employer:
How Long? To:
Monthly Income: $

Step 4. Tell us about your assets/liabilities.

*Combined Monthly Liabilities

Type	Monthly Payment	Unpaid Balance
Rent or Current Mortgage:	$
Credit Cards:	$	$
Auto Loans:	$	$
Other Loans:	$	$
Child Support:	$

Step 5. Tell us about your situation.

* I/We (borrower[s] named herein) understand that this form is for pre-qualification only and is not an application.

Authorization to check credit verification

You understand that by selecting the YES radio button immediately following this notice you are providing written instructions to Home Construction Lending Group under the Fair Credit Reporting Act authorizing Home Construction Lending Group to obtain information from your personal credit profile or other information from the credit bureau. You authorize Home Construction Lending Group to obtain such information solely in accordance with a Mortgage Loan Application.

YES NO

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Borrower Information

Borrower's Name:

Social Security Number and Age:

What are your telephone numbers?

Borrower's current address:

Borrower's former address:

Co-Borrower Information

Co-Borrowers Name:

Co-Borrower's SS Number and Age:

What are your telephone numbers?

Co-Borrower's current address:

Co-Borrower's former address:

Property Location

Property Address:

Property Type

Desired Mortgage Information

Property Details

Borrower

Current Employer:

Previous Employer:

Co-Borrower

Current Employer:

Previous Employer:

Borrower Assets

Co-Borrower Assets

*Combined Monthly Liabilities

Additional Comments:

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