GA Mortgage Licensee #12030, Equal Credit Lender
TOLL FREE NUMBER 1-888-507-4375
1129 Hospital Drive, Suite 1A · Stockbridge, Ga 30281
Office 770/507-4375 · Fax 770/507-4377

 
 
Prequalifying Worksheet
Primary Borrower - General Information

First Name: 

Last Name: 

Birth Date 
(MM-DD-YYYY):

Social Sec Number: 

Address: 

City: 

State: 

Zip: 

Phone: 

Email: 

Monthly Income: 

 *gross*

Time At Job: 

 *min 2 years*
 

List other job(s) if  
less than two years  
Co-Borrower (fill in only if a co-borrower is needed)
 

First Name: 

 

Last Name: 

 

Birth Date 
(MM-DD-YYYY):

 

Social Sec Number: 

 

Monthly Income: 

 *gross*
 

Time At Job: 

 *min 2 years*
 

List other job(s) if  
less than two years  
Other Monthly Income (if applicable)
 

Rental Income: 

 

Monthly Overtime: 

 

Monthly Bonus: 

 

Monthly Commission: 

Monthly Debts (installment debts and revolving accounts)
  Creditor Monthly Payment Unpaid Balance
1:
2:
3:
4:
5:
6:
7:
8:
 

Alimony, Child Support:

 
Current Housing Cost: 
 
Comments: 
 
Referring Agent: 
Send a copy to myself
  
 
Please type in the security code you see above.
 
Security Code:
Code is case sensitive! Use caps when needed.

Fill out all required information and click "Submit".

By clicking the "Submit" button, you understand that this information is being provided for information only and shall not constitute a firm loan commitment. You hereby authorize to release information in consideration for a loan.
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