PRE-QUALIFY ASSESSMENT DATA & PROFILE
Please Answer All Questions to the best of your ability.
Type "n/a" in any field if not applicable
Check one box below
Select and check box below with your mouse relative to loan type objectives as applicable.
A - Refinancing existing loan(s)
B - Equity Financing - (add 2nd or line of credit)
C - Equity Financing - (now free & clear)
Complete all fields below as applicable.
Who is your current Mortgage with?:
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How much is your current Monthly Mortgage Payment?:
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What is the Balance of your Mortgage?:
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Does your payment include Taxes and Insurance?:
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How much is your Annual Property Taxes?:
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How much is your Annual Homeowners Insurance Premium?:
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Do you have a Second Mortgage or Equity Line of Credit?:
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What is the Balance of your Second?:
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What is the payment on your Second?:
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Who holds you Second Mortgage?:
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What year did you purchase your home?:
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How much did you pay for your house?:
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How much do you think your House is Worth Today?:
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What type of property is your house? SFR or Condo or 2-4 unit, etc?:
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Is this your primary or investment Property?:
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Have you been late on your Mortgage in the last 12 months?:
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If yes, how late?:
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Did you ever file for Bankruptcy?:
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If yes, was it a Chapter 7 or 13?:
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If yes, when was it discharged?:
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Who do you currently work for?:
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How long have you worked there?:
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How much is your Annual Salary?:
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Where does your Spouse work?:
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How long has your spouse worked there?:
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What is the salary of your Spouse?:
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How much do you have in liquid assets? (Savings, Checking, 401k, etc.):
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Do you have any needs such as cash for home improvements or to pay off credit cards (Y/N)?:
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How much cash for home improvements and what kind of improvements?:
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How much cash for any other reason and what reason?:
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Visitor Name (your name):
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Your Date of Birth:
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Your Social Security Number:
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Name of your Spouse:
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Date of Birth of your Spouse:
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Social Security Number of your Spouse:
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Your Current Address (Number, Street, City, Zip):
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Address of Property if different from current address (Number, Street, City, Zip):
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Your home telephone number:
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Your work telephone number:
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Your cell phone number:
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Visitor email address (your email):
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Referred by:
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