Borrower Information Form
(This is NOT an application or commitment)

Fill in this form and submit.

The mortgage broker who is participating in this no-cost pre-application process tailors the best possible mortgage that will fit your particular situation. On average there are over 50 different types of mortgages available and almost always there is one just right for you. Your participating mortgage broker has access to dozens of investors willing to assist you in maximizing YOUR investment - your home.  The information you submit is confidential and is not sold or shown to anyone outside the context of purchasing your home.

The items marked in red must be filled in.

If not, the form will not successfully submit. Only serious applicants need apply: there is no obligation to select any mortgage offered by a participating mortgage broker.  Note, we do not ask for your social security number--it's not needed until you formally apply for a mortgage.

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YES NO Purchase? YES NO Refinance?  $ Purchase price  (if purchasing) $ Estimate value  (if refinancing) $ Existing mortgage (if refinancing) First Name (Yourself and/or Spouse) Last Name (Yourself and/or Spouse) Street City (Current) State Zip Home telephone (incl. area code) and/or Work telephone (at least one phone number                                                          required) Email Best time of day to be called (morn., aft., eve) City/Town of your new home State of your new home Planned purchase or re-finance date (mo/yr)  How long with current employer.  $Gross household income Credit rating (B or C or D - see "Rate Yourself" on previous page) YES  NO - Owner-occupied?  YES  NO - Single family house? YES  NO - Condo? YES  NO - Are you self employed? YES  NO - Foreclosure or bankruptcy in past 7 years?  YES  NO - Current tax liens or judgment?  Additional comments or special needs: