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Pre-qualification for Mortgage Loan Request

The information being furnished below is confidential and is not to be shared with anyone other than the lender to which it is being submitted and the REALTOR® who is assisting me in submitting this request.  This request does not in any way obligate me to finance any real estate purchase with the lender.  I understand that this is not a loan approval, but rather a pre-qualification to determine an amount that I should qualify for if I choose to purchase real estate.  Any final approvals shall be subject to an appraisal of the real estate along with satisfactory credit report as well as continued employment as represented herein along with any other requirements lender may require.  By submitting this pre-qualification to any of the participating lenders, I/We authorize the lender to order a mortgage credit report.
Borrower:   SSN:
Co-Borrower:    SSN:
Street:
City:     State:     Zip:  
Home Phone:
Work Phone: 
E-mail Address:


Income & Bills

Annual Income

Monthly Bills
Your annual income $ Auto Loans/Leases $
Spouse annual income Credit Cards
Rental income School Loans
Other income Personal Loans
Dividends/Interest Child Support
Total Combined
Annual income:		 Alimony
$ Total Mo. Bills: $
 Comments/Questions for Lender:
When loan pre-qualification is completed please notify:
BOTH myself and my REALTOR® | REALTOR®:
Only my REALTOR® | Email:
Only myself |


Please submit this request for pre-qualification to: (Choose one or more)
Realty Group Mortgage Bloomfield State Bank Farmers & Mechanics
IU Credit Union Monroe Bank