PRE-QUALIFICATION FORM NOTICE Please fill out our Pre-Qualification form below.Your data is secure and protected by 2048 bit Industry Standard SSL Certificate First Name* Middle Initial* Last Name* Date of Birth* Social Security Number* Your Email* Your Phone Number* Address* City* State* Zip Code* How Long At Current Address* ---1 year2 years3 years4 years5 years6 years7 years8 years9 years10 years11 years12 years13 years14 years15 years16 years17 years18 years19 years20 years21 years22 years23 years24 years25 years26 years27 years28 years29 years30 years30+ years Living Status at Address* ---OwnRentRent Free LOAN OFFICER Select Your Loan Officer* ---Team Member 1Team Member 2Team Member 3Please Provide One For Me INCOME NOTICE: Alimony, Child Support Or Separate Maintenance Income need not be revealed if the borrower or co-borrower does not choose to have it considered for repaying this loan. Gross Monthly Income* Additional Monthly Income* Source Of Additional Monthly Income* EMPLOYMENT STATUS Employment* ---EmployedSelf EmployedUnemployed ASSETS Checking* Savings* Retirement* Other* ADDITIONAL REAL ESTATE OWNED Do you own additional real estate?* ---YESNO ADDITIONAL DETAILS Marital Status* ---SingleMarriedSeparated Do you pay child support or Alimony* ---YESNO Is this a Purchase or Refinance? * ---PurchaseRefinance Are you a Veteran? * ---YESNO Are you a first time home buyer? * ---YESNO CO-BORROWER Do you have a co-borrower? * ---YESNO INFO FOR GOVERNMENT The Following Information Is Requested By The Federal Government For Certain Types Of Loans Related To A Dwelling In Order To Monitor The Lender's Compliance With Equal Credit Opportunity, Fair Housing And Home Mortgage Disclosure Laws. You Are Not Required To Furnish This Information, But Are Encouraged To Do So. The Law Provides That A Lender May Not Discriminate Either On The Basis Of This Information, Or On Whether You Choose To Furnish It. If You Furnish The Information, Please Provide Both Ethnicity And Race. For Race, You May Check More Than One Designation. If You Do Not Furnish Ethnicity, Race, Or Sex, Under Federal Regulations, This Lender Is Required To Note The Information On The Basis Of Visual Observation And Surname If You Have Made This Application In Person. If You Do Not Wish To Furnish The Information, Please Check The Box Below. Ethnicity * ---HispanicLatinoOther Race * ---American Indian Or Alaska NativeNative Hawaiian Or Other Pacific IslanderAsianAfrican AmericanOther Sex * ---MaleFemale AUTHORIZATION By checking this box, I grant that this information is to be used to pre-qualify me for a mortgage loan, including the right to obtain my credit report. I understand that the information will remain private and confidential. By submitting and signing this electronically, this application is to be deemed the equivalent of the original.