Welcome to our secure online pre-qualification form.
Once you submit your information it will receive immediate attention by one of our representatives.
Borrower Information
(Required information fields appear in
bold
)
First Name
M.I.
Last Name
Social Security Number
-
-
Date of Birth
/
/
Street
City
State
AA
AE
AK
AL
AP
AR
AS
AZ
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MP
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
--
Zip
Home Phone
-
-
Business Phone
-
-
x
Mobile/Pager/Alternate
-
-
Fax
-
-
Email Address
Contact Me at
Select One
Home Phone
Business Phone
Best Time to Call
Select One
Morning
Afternoon
Evening
Total Gross Yearly Income (Income Before Taxes)
*
$
*Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.
Notice: Alimony, child support, or separate maintenance income need not be revealed if the Borrower(B) or Co- Borrower(C) does not choose to have it considered for repaying this loan.
Total Monthly Debt Payments (including Alimony & Child Support)
$
Current Employer
Number of Years
Additional borrower Information
Will there be a additional borrower on this loan?
No additional borrower
Spouse
Other
First Name
M.I.
Last Name
Social Security Number
-
-
Date of Birth
/
/
Referral Information
Referred by
Loan Originator
Select a Loan Originator
Edward Carlton, President
Aimee Rafael, Loan Operations Manager
Alex Boeger
Christopher Carter
Heike Triplett
Jessie Kurland
Ronnie Gaydos Jr
If you would like to work with a specific loan originator, please select the name above.
Loan Information
Loan Purpose
Purchase
Refinance
Property Type
Select One
Primary Residence
Second Home/Vacation Home
Investment Property
Purchase Price
$
Amt Avail for Down Payment or Closing Costs
$
Credit Check Authorization
Do you authorize us to pull you and your additional borrower’s credit reports in order to pre-qualify you for a loan? (If so, please provide social security numbers and date of births).
Yes
No
Comments