subject_line
Mortgage Pre-Qualification Request
Applicant Information
Name
*
D.O.B.
*
+
SS# (000-00-0000)
*
Address:
Street
*
City
*
State
*
Zip Code
*
Time at Residence (years)
*
Phone# (000-000-0000)
*
Email
*
Current Monthly Mortgage Payment/Rent
*
Gross Monthly Income
*
Current Employer
*
Time at Employer (years)
*
Work Phone (000-000-0000)
*
Previous Employer if < 2 years
*
Co-Applicant Information
Applicable
*
Yes
No
Name
*
D.O.B.
*
+
SS# (000-00-0000)
*
Address:
Street
*
City
*
State
*
Zip Code
*
Time at Residence (years)
*
Phone# (000-000-0000)
*
Email
*
Current Monthly Mortgage Payment/Rent
*
Gross Monthly Income
*
Current Employer
*
Time at Employer (years)
*
Work Phone (000-000-0000)
*
Previous Employer if < 2 years
*
*
I certify that all information provided by me is true, correct and complete. I authorize Then Neffs National Bank to make whatever inquires about me necessary and appropriate for the purposes of evaluating my credit application. This includes credit reports and contacting my employer. I also authorize The Neffs National Bank to provide credit information about its credit experience with me to other creditors and credit reporting agencies.
For Backoffice Only: Date Received