Express Pre-Qualification
Form
(yellow fields are required)
Step 1. Tell us about you.
Borrower Information
Co-Borrower Information (If any)
What is the Borrowers Name?
What is the Co-Borrowers Name?
Title
Mr.
Mrs.
Miss.
First
Middle
Last
Title
Mr.
Mrs.
Miss.
First
Middle
Last
What is the Borrowers Address?
What is the Co-Borrowers Address?
Street
City
State
Zip
Street
City
State
Zip
What is your Social Security number and Age?
What is your Social Security number and Age?
SSN#
Age
SSN#
Age
What are your telephone numbers?
What are your telephone numbers?
Home
Home
Work
Work
Step 2. Tell us about your situation.
What is the property address?
Street
City
State
Zip
Number of units:
1
2
3
4
Occupancy type: :
.
Secondary Residence
Primary Residence
Investment
Estate Held:
.
Fee Simple
Leasehold
Property Value: $
What is the type of mortgage loan?
Conventional
VA
FHA
FmHA
Other
What is the Program Type?
Fixed Rate
GPM
ARM
Other
What is the purpose of this loan?
Purchase
Refinance
Construction
Construction-to-Perm
Other
If you selected "Other", please explain.
What is the desired loan amount?
$
If purchase, what is the estimated purchase price?
$
What is the estimated down payment amount?
$
If refinance, what is the total owed on home?
$
What is the length of your requested loan in months?
--
.
84 months
120 months
180 months
240 months
360 months
Step 3. Tell us about your employment.
Borrower
Co-Borrower
Self Employed?
Yes
No
Employer:
How Long (Yrs/Mths):
/
Monthly Income:
$
Overtime:
$
Bonuses:
$
Commissions:
$
Other:
$
Self Employed?
Yes
No
Employer:
How Long (Yrs/Mths):
/
Monthly Income:
$
Overtime:
$
Bonuses:
$
Commissions:
$
Other:
$
Step 4. Tell us about your assets/liabilities.
Borrower Assets
Co-Borrower Assets
Checking:
$
Savings:
$
Stock $
Bond $
401K's/IRA's
$
Checking:
$
Savings:
$
Stock $
Bond $
401K's/IRA's
$
Combined Monthly Liabilities
Type
Monthly Payment
Unpaid Balance
Credit Cards:
$
$
Auto Loans:
$
$
Other Loans:
$
$
Child Support:
$
Other Information
Which describes your situation?
I am a first time home buyer
I need to sell my existing house before I buy another
I am only interested in a pre qualification I am not realdy to buy yet
I am working with a Realtor and ready for financing!
I have not hired a Realtor yet but I"d like to get started
I want to refinance and get cash out.
I want to do a streamline refinance of my VA or FHA loan
Other
I have found a real estate agent.
Additional Comments:
Yes
___
No
Agents Name:
Company:
Phone Number:
I need a realtor, please have one contact me.
Yes
___
No
* I/We (borrower[s] named herein) understand that this form is for pre-qualification only and is not an application.
Authorization to check credit verification
Yes
______
No
By selecting "YES" to this radio button, I/WE hereby authorize AmeriTex Mortgage to order a consumer credit report to verify credit and other information pertaining to pre-qualification. The information that obtains is only to be used for mortgage pre-qualification purposes.
Email Address: