Mortgage Questionnaire

Get pre-approved, and negotiate the best price and terms with my Certificate of Loan Commitment from a locally owned bank.
BORROWER INFORMATION CO-BORROWER INFORMATION
Borrower’s Name
Co-Borrower’s Name
Borrower’s Social Security # & Date of Birth
&
Co-Borrower’s Social Security # & Date of Birth
&
Year of School Completed
Year of School Completed
Marital Status Number/Ages of Dependents
Marital Status Number/Ages of Dependents
Address
Address
Time at This Address Landlord’s Name (if applicable)
Time at This Address Landlord’s Name (if applicable)
Approximate Home Value (if homeowner)
Approximate Home Value (if homeowner)
Home Phone Work Phone Cell Phone
Home Phone Work Phone Cell Phone
Email Address
Email Address
Employer
Employer
Job Title
Job Title
Time at This Job Monthly Gross Income
Time at This Job Monthly Gross Income
Bank Accounts At Account Balance
Bank Accounts At Account Balance
Other Liquid Assets (401K, IRAs, stock, etc.)
1.
2.
3.
Other Liquid Assets (401K, IRAs, stock, etc.)
1.
2.
3.
Automobiles You Own (year, make, value)
1.
2.
3.
Automobiles You Own (year, make, value)
1.
2.
3.

"By submitting this form, I/we authorize Gary Moore and PrimeTrust Bank to
access my/our credit report for the purpose of pre-qualifying for a loan"

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