Get Prequalified. Form

Purchase/Loan Preliminary Qualifier

Borrower Information: * - Required fields
First Name:*
Last Name:*
SS NUMBER:
Date of Birth:
Home Address:
City:
State:	Zip:
Email Address:*

Co-Borrower Information:
First Name:
Last Name:
SS NUMBER:
Date of Birth:
Home Address:
City:
State:	Zip:
Email Address:

Note: Please be assured that your e-mail address will never be sold, shared or used for any other purpose without your permission.

Phone Number* (at least one phone number is required):
Home Phone:
Work Phone:

Phone Number (at least one phone number is required):
Home Phone:
Work Phone:

Note: By submitting your telephone number you are consenting to being contacted by me and/or my authorized representatives via
telephone and/or e-mail, even if your name appears on the Federal "Do-not-call List."

Monthly income:*
Income from other sources:*
What is the other source?*
Are you currently paid by hour? Yes No
If so, what is your hourly rate?
How many hour do you average per week?
If salaried what is your salary?
What do the minimum payments add up on your monthly debt?* (Include installment debt, student loans, revolving credit cards, car payments et...)

Monthly income:
Income from other sources:
What is the other source?
Are you currently paid by hour? Yes No
If so, what is your hourly rate?
How many hour do you average per week?
If salaried what is your salary?
What do the minimum payments add up on your monthly debt? (Include installment debt, student loans, revolving credit cards, car payments et...)

Do you	alimony or child support? If yes how mach $ per month?
How much find do you have available for down, closing costs & reserves?
Source of Down Payment:	Savings Gifts from Relatives Checking Others
Any credit problems that your are aware of? If so please describe the problem:


		SUBMIT

Martin Witter

CENTURY 21 Select Real Estate
7919 Pebble Beach Dr, Ste 101, Citrus Heights, CA 95610

Direct: (916) 425-5184
Office: (916) 363-8116
FAX: (916) 363-8116
E-mail: martin@martinwitter.com
Web Page: http://martinwitter.com

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