Home Mortgage Refinancing Second Mortgage Quote Mortgage Loan No money down Mortgage Lender Zero Down

New Pre-Application Form

Please fill out all fields below and click the Next button when you have completed this form.

Amount Requested $

In fields marked with this star please input currency or percentages without the dollar sign ($) or the percent sign (%).

Type of Loan:

-- Purchase Refinance Cash Out Refi Credit Line Equity / 2nd Loan Construction Perm Construction Other

Loan Program Requested:

-- Fixed 30 Year Fixed 15 Year Adjustable Other

Occupancy Type:

-- Primary Secondary Investment

Estimated Present Value $

Year Purchased:

Purchase Price $

*This is a required field* Property State:

-- AK CA CO CT DC DE FL GA IA ID IL IN LA MA MD ME MI MN MO MT NC ND NH NJ NM NY OH OR PA RI SC SD TN TX UT VA VT WA WI WV WY Why my state is not in the list?

Property Type:

-- Single Family Condo Townhouse 2 to 4 Family Commercial Other

First Mortgage Type:

-- Fixed Adjustable Balloon Other

First Mortgage Current Rate %

First Mortgage Balance $

Second Mortgage Current Rate %

Second Mortgage Balance $

Middle Name:

Last Name:

Generation(Jr.,Sr.,III):

Date of Birth:

/ /

Social Security Number:

Address 1:

Address 2:

City:

State:

-- AK CA CO CT DC DE FL GA IA ID IL IN LA MA MD ME MI MN MO MT NC ND NH NJ NM NY OH OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip Code

Home Phone:

Fax Number:

Email Address:

How shall we contact you?:

Middle Name:

Last Name:

Generation(Jr.,Sr.,III):

Date of Birth:

/ /

Social Security Number:

Address 1:

Address 2:

City:

State:

-- AK CA CO CT DC DE FL GA IA ID IL IN LA MA MD ME MI MN MO MT NC ND NH NJ NM NY OH OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip Code

Home Phone:

Fax Number:

Email Address:

How shall we contact you?:

Employment Position:

Years Employed:

Months: 0 1 2 3 4 5 6 7 8 9 10 11

Work Phone:

Monthly Income $

Self Employed:

No Yes

Employment Position:

Years Employed:

Months: 0 1 2 3 4 5 6 7 8 9 10 11

Work Phone:

Monthly Income $

Self Employed:

No Yes

Total Credit Card Debt:

Payoff ? Yes No

Total Auto Debt:

Payoff ? Yes No

Personal Debt:

Payoff ? Yes No

Mortgage History:

Never 30 days late One 30 day late Some 30 days late Some 60 days late Some 90 days late

Revolving Debt / Installment History:

Never 30 days past due Some 30 days past date due Some 60 days past date due Some 90 days past due or some collections and chargeoffs

Have you had a Foreclosure or Bankruptcy in the past 7 years?

Never 3-7 Years 2-3 Years 1-2 Years Less than 1 year ago

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 neither discriminate on the basis of this information, nor on whether you choose to furnish it. However, if you choose not to furnish it, under Federal regulations this Lender is required to note race and sex on the basis of visual observation or surname. If you do not wish to furnish this information, please choose the appropriate selection from the dropdown box.

I do not wish to provide this information American Indian, Alaskan Native Asian Pacific Islander Black, not of Hispanic origin Hispanic White, not of Hispanic origin Other (specify)

If Other, please describe:

I do not wish to provide this information Female Male

I do not wish to provide this information American Indian, Alaskan Native Asian Pacific Islander Black, not of Hispanic origin Hispanic White, not of Hispanic origin Other (specify)

If Other, please describe:

I do not wish to provide this information Female Male

*Please choose the appropriate choices below and then press the Finished button. If you choose "My Pre-Application IS Complete", The Mortgage Shop will begin to process your loan immediately. If you choose "My Pre-Application IS NOT Complete", you will be able to log back into your pre-application at a later time and make changes to your entries.

My Pre-Application IS Complete My Pre-Application IS NOT Complete

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