Qualification Form

Borrower Information

1. Full Name:
2. Address:
3. City:
4. State: AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
5. Zip:
6. Home Phone:
7. Cell Phone:
8. E-Mail:
9. Date of Birth:
10. Last Four Social Security:

Co-Borrower Information

1. Full Name:
2. E-Mail:
3. Date of Birth:
4. Last Four Social Security:

Loan Information

• 1st Mortgage
• 2nd Mortgage (optional)

1. Notice of Default: Yes No
2. In Foreclosure: Yes No
3. HOA Dues:
4. Value of Home:
5. In Bankrupcty: Yes No
6. File Date:
7. Primary Residence: Yes No
8. Other Properties: Yes No
9. Year Purchased:
10. Loan Has Impounds: Yes No
11. Gross Monthly Income:
12. Net Monthly Income:
13. Property Taxes:
14. Insurance:
15. Payments: