1) Your full name

2) Do you currently own or rent?

3) What is your current monthly housing payment?

4) How many late payments have you had on your housing payment in the past year?

5) How long have you been with your current employer?

6) What is your gross monthly family income?

7) Can you document your income with W-2's and/or tax returns for the past 2 years? Yes No

8) What are your total monthly debt payments?

9) How would you rate your credit score?

10) Purpose of the loan.

11) Approximate loan amount.

12) Approximate value of the home.

13) What type of property is it?

14) How much money do you have to use for the down payment and closing costs?

15) In what STATE is the home?

16) Contact phone #1

17) Contact phone #2

18) Email address

19) Best time to contact me with prequalification figures?

20) Comments: Briefly summarize what you are trying to accomplish in applying for the new loan, or any comments you consider important for me to know.

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