Please fill out this short  form to receive a FREE  Pre-Qualification with no obligation.

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PERSONAL INFORMATION

	Borrower	Co-Borrower
First Name
Last Name
Current Address
City, State Zip	,	,
Self-Employed	No Yes	No Yes
Employer's Name
Years with Employer
Gross Monthly Income

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PROPERTY INFORMATION

Loan Purpose	Choose Purchase Refinance 1st Mortgage Only Refinance 1st and 2nd Mortgage Refinance to consolidate debts Refinance to take cash out	New Construction	No Yes
Property Type	Choose From List Single Family Home Townhome Condominium Duplex 3-Unit 4-Unit	Property Value
Loan Use	Choose From List Primary Residence Second/Vacation Home Investment Property	Tentative Closing
Loan Amount		Property State

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Which of the following Mortgage Programs are you interest in?
(check all that apply)

Fixed Rate Programs: 30 Year   25 Year   20 Year   15 Year   10 Year

Adjustable Rate Programs: 7/1 ARM   5/1 ARM   3/1 ARM   1/1 ARM   60 MTA

Other Programs: 2/1 Buy Down 7/23 Balloon FHA VA Other:

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CURRENT CREDIT OBLIGATIONS (please use estimates)

Mortgage Balance	Minimum Monthly Payment	Type of Mortgage	Balance to be paid with Loan Proceeds?
		Choose From List 1st Mortgage 2nd Mortgage Home Equity	No Yes
		Choose From List 1st Mortgage 2nd Mortgage Home Equity	No Yes

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Loan(s) and/or Credit Card(s):

Current Balance	Minimum Monthly Payment	Type of Loan	Balance to be paid with Loan Proceeds?
		Choose From List Auto Education Personal Credit Card Other	No Yes
		Choose From List Auto Education Personal Credit Card Other	No Yes
		Choose From List Auto Education Personal Credit Card Other	No Yes

CONTACT INFO

	Borrower	Co-Borrower
E-mail Address
Home Phone
Work Phone
Best Time To Contact	Choose Anytime 6-9 AM (MST) 9-12 AM (MST) 12-3 PM (MST) 3-7 PM (MST)	Choose Anytime 6-9 AM (MST) 9-12 AM (MST) 12-3 PM (MST) 3-7 PM (MST)

 

How did you hear about us?

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COMMENTS
Any other income, credit, or other information that you feel we might need to know:

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AUTHORIZATION

Borrower's Social Security Number (optional)
Co-Borrower's Social Security Number (optional)

  I/We hereby authorize the recipient to check my/our credit, business, and employment history for the purpose of obtaining a mortgage.