Pre-Qualification Form

Estimate Purchase Price: $ Estimated Down Payment: $

Personal Information

Buyer:

Name: SSN: DOB:
Address: Phone: Email:
City: Street: ZIP:
Own: Rent: # of Years:
Married: Single: Divorced: Separated: # of Children: Ages:

Co-Buyer

Name: SSN: DOB:
Address: Phone: Email:
City: Street: ZIP:
Own: Rent: # of Years:
Married: Single: Divorced: Separated: # of Children: Ages:

Employment/Income Information

Buyer

Employer: Phone: Address:
City: State: ZIP:
Position: Hire Date: # of Yrs. Same Line of Work:
Monthly Income: $ Other Income: $ Source:

Co-Buyer

Employer: Phone: Address:
City: State: ZIP:
Position: Hire Date: # of Yrs. Same Line of Work:
Monthly Income: $ Other Income: $ Source:

Assets/Source of Funds

Please indicate source of funds for down & closing costs

Bank Accounts: $ Stocks/Bonds: $
Gift Funds: $ 401k: $
What is the present value of your home? $ Will you SELL or RENT your current residence?