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Mortgage Pre-qualifying request form

Borrower's Name
Home Phone
Work Phone
Social Security Number
Address
Number of years residing
Employment:
Number of years employed:
Existing Monthly Housing Expense (Rent or Mortgage)
Gross Monthly Income:
If you have been at your current employer for less than 2 years, please indicate to us your previous employer and number of years there.
Monthly Credit Card Payments
Monthly Car Payments
Other Monthly Expenses
`Have you been 30 or more days late on any account in the last 12 months? Yes No
Have you ever filed bankruptcy?	Yes No
Discharge Date
Please complete the section below if you have a co-borrower, if not, check the data above; then submit. Co-Borrower's Information
Co-Borrower's Name
Home Phone:
Work Phone:
Social Security Number:
Address:
Number of years residing :
Existing Monthly Housing Expense (Rent or Mortgage)
Gross Monthly Income:
Employment:
Number of years employed:
If you have been at your current employer for less than 2 years, please indicate to us your previous employer and number of years there:

Gross Monthly Income
Existing Monthly Housing Expense (Rent or Mortgage)
Monthly Credit Card Payments
Monthly Car Payments
Other Monthly Expenses
Have you been 30 or more days late on any account in the last 12 months? Yes No
Total Liquid (Cash) Assets available
Have you ever filed bankruptcy?	Yes No
Discharge Date
By Submitting this form, you understand and agree to contact a Real Estate Marketing Company known as Internet Realty Group, Inc., and grant permission for an Internet Realty Group, Inc. agent or representative to contact you for the purpose of buying or selling Real Property. You are under no further obligation.