Dayton Ohio Area
SecondMortgage / Home Equity Loan / Line of Credit
Pre qualification Form
Please use your initials or first name with last initial if you wish to remain anonymous.
We do not ask for account or social security numbers, or check credit at this stage.
If unsure about an answer please leave it blank. Thanks!
This form will take about 3 minutes to complete.
PLEASE USE THE TAB KEY DO NOT USE THE ENTER KEY
LOAN INFORMATION:
What is the loan amount requested?
Type of loan requested?
If other, please describe:
Is this loan being used to pay off an existing first or second mortgage?
What is the purpose of the loan?
If other, please describe:
What is the term desired?
EXISTING FIRST MORTGAGE:
What is the type of the first mortgage?
What was the original loan amount?
What is the estimated loan balance?
What was the original loan term?
Is this a fixed rate mortgage?
What is the interest rate?
What is your current mortgage payment?
Does your current mortgage payment include taxes?
Does your current mortgage payment include insurance ?
Is there any subsidy or recapture?
In the past 12 months, how many times has your mortgage payment been more than 30 days late?
Has your mortgage payment been more than 60 days past due in the last 24 months?
Have there been any other payments (car, credit card, etc.) more than 30 days past due in the last 12 months?
PROPERTY INFORMATION:
Property address:
(You may just type in the county if you choose).
State (Required):
Type of property:
If other, describe:
What is the estimated market value?
What was the original purchase price?
Property use:
BORROWER'S INFORMATION:
Borrower's name or initials (Required):
Borrower's address (optional):
How long have you lived at this address?
E-mail Address (Required):
Daytime phone (Required):
Evening phone (Required):
What is your yearly gross income from all sources (before taxes)?
Will you document your income (provide pay stubs, w-2's, tax returns)?
Would you prefer to state your income or use a no doc program?
Are you self-employed?
If self-employed, for how many years?
Rate your credit:
What is your credit score (if known)?
Have you filed bankruptcy in the last 7 years?
BORROWER'S TOTAL MONTHLY DEBTS
(less credit cards and debt being paid off by this loan):
Car or other installment:
Student loans:
Other (child support, garnishments, etc.):
BORROWER'S CREDIT CARDS:
Total estimated balance (not including those paid in full each month or being paid off by this loan):
Monthly payment amount (not including those paid in full each month or being paid off by this loan):
CO-BORROWER'S INFORMATION:
Co-borrower's name or initials:
Co-borrower's address (optional):
How long have you lived at this address?
E-mail:
Daytime phone (optional):
Evening phone (optional):
What is your yearly gross income from all sources (before taxes)?
Will you document your income (provide pay stubs, w-2's, tax returns)?
Would you prefer to state your income or use a no doc program?
Are you self-employed?
If self-employed, for how many years?
Rate your credit:
What is your credit score (if known)?
Have you filed bankruptcy in the last 7 years?
CO-BORROWER'S TOTAL MONTHLY DEBTS
(less credit cards and debt being paid off by this loan)
Please do not include joint accounts already listed in borrower section:
Car or other installment:
Student loans:
Other (child support, garnishments, etc.):
CO-BORROWER'S CREDIT CARDS
Please do not include joint accounts already listed in borrower section:
Total estimated balance (not including those paid in full each month or being paid off by this loan):
Monthly payment amount (not including those paid in full each month or being paid off by this loan):
ADDITIONAL INFORMATION:
Please provide any additional information that will help us assist you:
If you have a second mortgage tell us here:
How did you find our website (which search engine, i.e. Yahoo, AOL etc. or other source)?
Please contact theat the above.

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