This pre-qualification form does not constitute an application or a commitment to lend. This pre-qualification is not an indication of the actual loan type or amount for which you may qualify.

Purpose of Loan	Purchase Refinance Home Equity (Cash Out)
Property Value
Loan Program	Fixed Balloon (Int Only) Adjustable
Loan Amount	$ or % Down Payment
Is there a co-borrower?	Yes No
Full Name	*
E Mail Address
Fax
Street Address	*
City	*
State	*
Zip	*
When do you think you will actively start viewing properties?
Are you employed?
Are you a first time buyer?	Yes No
Contact Me at:	Home Work
Home Number	*
Work Number	*
Fax
Best Time to call
My/Our Credit History	Excellent Ok, bt some problems Major Credit Problems Don't Know
Questions / Comments

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