Refinance Pre-Qualification Worksheet

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How did you hear about us?
Referred by:

1. Property Information:
    Current Address:
    Street:
    City:   State:   ZIP:

    Approximate Market Value of Home:
    Approximate Existing Loan Balances:
    Specify amount of cash you would like to receive after paying off existing mortgage balance(s), if any:
    This home is: (select one)
    Primary Residence  Second Home  Investment Property

2. Do you plan to include home improvements with this refinance?
Yes   No
Amount of home improvements:

3. Would you like to consider including closing costs in the loan amount?
Yes   No

4. Term of Mortgage Requested:
 Years
Type: (select one)
ARM  Fixed  Undecided

5. How long have you owned this property?
 Years
Current monthly payment:

6. How long since your last financing/refinancing of this property?
 Years

7. Has this property been listed for sale in the last 12 months?
Yes   No

8. Title to be held in the name(s) of:

9. Borrower Information:

    Married   Unmarried
    First Name:   Middle:   Last:
    Date of Birth (mm/dd/yyyy):
    Years in School:
    Number of Dependents:
Co-Borrower:
    Married   Unmarried
    First Name:   Middle:   Last:
    Date of Birth (mm/dd/yyyy):
    Years in School:
    Number of Dependents:

10. Contact Information
Borrower Co-Borrower
Daytime Phone:
Home Phone:
Work Phone:
Cell Phone
FAX:
E-mail:
Daytime Phone:
Home Phone:
Work Phone:
Cell Phone
FAX:
E-mail:

11. Employer Information: (2 year history)

    Employer Name:
    Street Address:
    City:   State:   ZIP:
    Employer Phone:
    Job Title:  
    Years, Months with current employer.
    # Years at this type of work:
    Corporate Relocation? Yes   No  
    Are you self-employed? Yes   No  

If less than 2 year history at current job, fill out for previous employer

    Employer Name:
    Street Address:
    City:   State:   ZIP:
    Employer Phone:
    Employed from (mm/dd/yyyy) to

12. Co-Borrower's Employer Information: (2 year history)

    Employer Name:
    Street Address:
    City:   State:   ZIP:
    Employer Phone:
    Job Title:  
    Years, Months with current employer.
    # Years at this type of work:
    Corporate Relocation? Yes   No  
    Are you self-employed? Yes   No  

If less than 2 year history at current job, fill out for previous employer

    Employer Name:
    Street Address:
    City:   State:   ZIP:
    Employer Phone:
    Employed from (mm/dd/yyyy) to
13. List monthly income and sources of income.
Gross Monthly Income Borrower Co-Borrower
Base Employee Income $ $
Overtime $ $
Bonuses $ $
Commissions $ $
Dividends/Interest $ $
Net Rental Income $ $
$ $
$ $
Totals:


14. List primary assets such as bank (checking, savings, IRA), investment, retirement accounts, stock options, real estate.
Assets Source Name of Institution


15. List liabilities that are not paid off on a monthly basis.
Liabilities Source
Balance Payment Debt Type Creditor

16. Are there any judgments, lawsuits, bankruptcy (last 10 years), foreclosures, alimony, child support, or indirect credit obligations (guarantees or co-signing) we should be aware of?
Yes  No

If "Yes", please describe:


17. Are the borrowers...
U.S. Citizens? Yes  No

If "No", Visa Type:

18. Do you own 25% or more of any Corporation or Partnership, or derive 25% or more of your income from commissions?
Yes   No

If "Yes", please describe:


19. Are you applying for a government loan?
FHA   VA  


Any Additional Information:

NOTE: Please print a copy for your file before submitting.