Printable Mortgage Prequalification Application
~ Print, complete, and mail to P.O. Box 1248, Columbus, MS 39703, or Fax to (662) 329-5995, unless otherwise instructed by your originator ~
I. TYPE OF MORTGAGE AND TERMS OF LOAN
Mortgage Applied for:
VA
FHA
Conventional
FmHA
Other:
Agency Case Number
Lender Case Number
Amount $
Interest Rate
No. of Months
Amortization Type:
Fixed Rate
GPM
Other (explain):
ARM (type):
II. PROPERTY INFORMATION AND PURPOSE OF LOAN
Subject Property Address (street, city, state, & zip code)
No. of Units
Legal Description of Subject Property (attach description if necessary)
Year Built
Purpose of Loan
Purchase
Refinance
Construction
Construction-Permanent
Other (explain):
Property will be:
Primary Residence
Secondary Residence
Investment
Complete these two lines if this is a construction or a construction-permanent loan.
Year Lot Acquired
Original Cost $
Amount Existing Liens $
(a) Present Value of Lot $
(b) Cost of Improvements $
Total (a + b) $
Complete these two lines if this is a refinance loan.
Year Acquired
Original Cost $
Amount Existing Liens $
Purpose of Refinance
Describe Improvements
made to be made
Cost: $
Title will be held in what Name(s)
Manner in which Title will be held
Estate will be held in:
Fee Simple
Leashold
(show expiration date)
Source of Down Payment, Settlement Charges and/or Subordinate Financing (explain)
III. BORROWER INFORMATION
Borrower
Borrower's Name (include Jr. or Sr. if applicable)
Social Security Number
Home Phone (incl. area code)
Age
Yrs. School
Married
Separated
Unmarried (include single, divorced, widowed)
Dependents (not listed by Co-Borrower)
no. ages
Present Address (street, city, state, zip code)
Own
Rent
______No. Yrs.
If residing at present address for less than two years, complete the following:
Former Address (street, city, state, zip code)
Own
Rent
______No. Yrs.
Former Address (street, city, state, zip code)
Own
Rent
______No. Yrs.
Co-Borrower
Co-Borrower's Name (include Jr. or Sr. if applicable)
Social Security Number
Home Phone (incl. area code)
Age
Yrs. School
Married
Separated
Unmarried (include single, divorced, widowed)
Dependents (not listed by Co-Borrower)
no. ages
Present Address (street, city, state, zip code)
Own
Rent
______No. Yrs.
If residing at present address for less than two years, complete the following:
Former Address (street, city, state, zip code)
Own
Rent
______No. Yrs.
Former Address (street, city, state, zip code)
Own
Rent
______No. Yrs.
IV. EMPLOYMENT INFORMATION
Borrower
Name & Address of Employer
Self Employed
Yrs. on this job
Yrs. employed in this line of work/profession
Position/Title/Type of Business
Business Phone (incl. area code)
If employed in current position for less than two years or if currently employed in more than one position, complete the following:
Name & Address of Employer
Self Employed
Dates (from-to)
Monthly Income $
Position/Title/Type of Business
Business Phone (incl. area code)
Name & Address of Employer
Self Employed
Dates (from-to)
Monthly Income $
Position/Title/Type of Business
Business Phone (incl. area code)
Co-Borrower
Name & Address of Employer
Self Employed
Yrs. on this job
Yrs. employed in this line of work/profession
Position/Title/Type of Business
Business Phone (incl. area code)
If employed in current position for less than two years or if currently employed in more than one position, complete the following:
Name & Address of Employer
Self Employed
Dates (from-to)
Monthly Income $
Position/Title/Type of Business
Business Phone (incl. area code)
Name & Address of Employer
Self Employed
Dates (from-to)
Monthly Income $
Position/Title/Type of Business
Business Phone (incl. area code)
V. MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION
Gross Monthly Income
Borrower
Co-Borrower
Total
Combined Monthly Housing Expense
Present
Proposed
Base Empl. Income*
$
$
$
Rent
$
Overtime
First Mortgage (P & I)
$
Bonuses
Other Financing (P & I)
Commissions
Hazard Insurance
Dividends/Interest
Real Estate Taxes
Net Rental Income
Mortgage Insurance
OTHER (before completing, see the notice in "describe other income," below)
Homeowner Assn. Dues
Other:
Total
$
$
$
Total
$
$
Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.
Describe Other Income Notice: Alimony, child support, or separate maintenance income need not be revealed if the Borrower (B) or Co-Borrower (C) does not choose to have it considered for repaying this loan.
B/C
Monthly Amount
$
VI. ASSETS AND LIABILITIES
This Statement and any applicable supporting schedules may be completed jointly by both married and unmarried Co-Borrowers if their assets and liabilities are sufficiently joined so that the Statement can be meaningfully and fairly presented on a combined basis; otherwise separate Statements and Schedules are required. If the Co-Borrower section was completed about a spouse, this Statement and supporting schedules must be completed about that spouse also.
Real estate owned (enter market value from schedule of real estate owned)
$
Vested interest in retirement fund
$
Net worth of business(es) owned (attach financial statement)
$
Automobiles owned (make and year)
$
Other Assets (itemize)
$
Total Assets a.
$
Liabilities and Pledged Assets. List the creditor's name, address and account number for all outstanding debts, including automobile loans, revolving charge accounts, real estate loans, alimony, child support, stock pledges, etc. Use a continuation sheet, if necessary. Indicate by (*) those liabilities which will be satisfied upon sale of real estate owned or upon refinancing of the subject property.
LIABILITIES
Monthly Payt. & Mos. Left to Pay
Unpaid Balance
Name and address of Company
$ Payt./Mos.
$
Acct. No.
Name and address of Company
$ Payt./Mos.
$
Acct. No.
Name and address of Company
$ Payt./Mos.
$
Acct. No.
Name and address of Company
$ Payt./Mos.
$
Acct. No.
Name and address of Company
$ Payt./Mos.
$
Acct. No.
Name and address of Company
$ Payt./Mos.
$
Acct. No.
Name and address of Company
$ Payt./Mos.
$
Acct. No.
Alimony/Child Support/Separate Maintenance Payments Owed to:
$
Job Related Expense (child care, union dues, etc.):
$
Total Monthly Payments
$
Total Liabilities b.
$
Net Worth (a minus b)
$
VII. DETAILS OF TRANSACTION
a. Purchase price
$
b. Alterations, improvements, repairs
c. Land (if acquired separately)
d. Refinance (incl. debts to be paid off)
e. Estimated prepaid items
f. Estimated closing costs
g. PMI, MIP, Funding Fee
h. Discount (if Borrower will pay)
i. Total costs (add items a through h)
j. Subordinate financing
k. Borrower's closing costs paid by Seller
l. Other Credits (explain)
m. Loan amount (exclude PMI, MIP, Funding Fee financed)
n. PMI, MIP, Funding Fee financed
o. Loan amount (add m & n)
p. Cash from/to Borrower (subtract j, k, l & o from i)
VIII. DECLARATIONS
If you answer "yes" to any questions a through i, please use a continuation sheet for explanation.
Borrower
Co-Borrower
a. Are there any outstanding judgements against you?
Yes
No
Yes
No
b. Have you been declared bankrupt within the past 7 years?
Yes
No
Yes
No
c. Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?
Yes
No
Yes
No
d. Are you a party to a lawsuit?
Yes
No
Yes
No
e. Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgement? (This would include such loans as home mortgage loans, SBA loans, home improvement loans, educational loans, manufactured (mobile) home loans, any mortgage, financial obligation, bond, or loan guarantee. If "Yes," provide details, including date, name and address of Lender, FHA or VA case number, if any, and reasons for the action.)
Yes
No
Yes
No
f. Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee? If "Yes," give details as described in the preceding.
Yes
No
Yes
No
g. Are you obligated to pay alimony, child support, or separate maintenance?
Yes
No
Yes
No
h. Is any part of the down payment borrowed?
Yes
No
Yes
No
i. Are you a co-maker or endorser on a note?
Yes
No
Yes
No
j. Are you a U.S. citizen?
Yes
No
Yes
No
k. Are you a permanent resident alien?
Yes
No
Yes
No
l. Do you intend to occupy the property as your primary residence? If "Yes," complete question m below.
Yes
No
Yes
No
m. Have you had an ownership interest in a property in the last three years?
Yes
No
Yes
No
(1) What type of property did you own - principal residence (PR), second home (SH), or investment property (IP)?
______________
______________
(2) How did you hold title to the home - solely by yourself (S), jointly with your spouse (SP), or jointly with another person (O)?
______________
______________
IX. ACKNOWLEDGEMENT AND AGREEMENT
The undersigned specifically acknowledge(s) and agree(s) that: (1) the loan requested by this application will be secured by a first mortgage or deed of trust on the property described herein; (2) the property will not be used for any illegal or prohibited purpose or use; (3) all statements made in this application are made for the purpose of obtaining the loan indicated herein; (4) occupation of the property will be as indicated above; (5) verification or reverification of any information contained in the application may be made at any time by the Lender, its agents, successors and assigns, either directly or through a credit reporting agency, from any source named in this application, and the original copy of this application will be retained by the Lender, even if the loan is not approved; (6) the Lender, its agents, successors and assigns will rely on the information contained in the application and I/we have a continuing obligation to amend and/or supplement the information provided in this application if any of the material facts which I/we have represented herein should change prior to closing; (7) in the event my/our payments on the loan indicated in this application become delinquent, the Lender, its agents, successors and assigns, may, in addition to all their other rights and remedies, report my/our name(s) and account information to a credit reporting agency; (8) ownership of the loan may be transferred to successor or assign of the Lender without notice to me and/or the administration of the loan account may be transferred to an agent, successor or assign of the Lender with prior notice to me; (9) the Lender, its agents, successors and assigns make no representations or warranties, express or implied, to the Borrower(s) regarding the property, the condition of the property, or the value of the property. Certification: I/We certify that the information provided in this application is true and correct as of the date set forth opposite my/our signature(s) on this application and acknowledge my/our understanding that any intentional or negligent misrepresentation(s) of the information contained in this application may result in civil liability and/or criminal penalties including but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Section 1001, et seq. and liability for monetary damages to the Lender, its agents, successors and assigns, insurers and any other person who may suffer any loss due to reliance upon any misrepresentation which I/we have made on this application.
Borrower's Signature
X
Date
Co-Borrower's Signature
X
Date
X. INFORMATION FOR GOVERNMENT MONITORING PURPOSES
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. You may select one or more designations for "Race." The law provides that a lender may not discriminate on the basis of this information, or on whether you choose to furnish it. However, if you choose not to furnish the information and you have made this application in person, under federal regulations the lender is required to note ethnicity, race, and sex on the basis of visual observation or surname. If you do not wish to furnish the information, please check below.
Applicant
Co-Applicant
Ethnicity:
Hispanic or Latino
Not Hispanic or Latino
Ethnicity:
Hispanic or Latino
Not Hispanic or Latino
Race:
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Race:
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
