Please fill out the form below completely and make sure you click on the Submit button at the bottom of the form.
Borrower:
Full Legal Name: (required)
Birth Date: (required)
Home Telephone: (required)
Work Telephone: (required)
Current Address: (required)
City: (required)
State: (required)
Zip / Postal Code: (required)
Email Address: (required)
Social Security Number: (required)
Gross Monthly Income: * (required)
Type of Income: (required)
* NOTE: If you are self-employed, deduct business expenses and use net income. If hourly, rate per hour.
Co-Borrower:
Full Legal Name: (required)
Birth Date: (required)
Home Telephone: (required)
Work Telephone: (required)
Current Address: (required)
City: (required)
State: (required)
Zip / Postal Code: (required)
Email Address: (required)
Social Security Number: (required)
Gross Monthly Income: * (required)
Type of Income: (required)
* NOTE: If you are self-employed, deduct business expenses and use net income. If hourly, rate per hour.
Current Obligations **
Description Monthly Payment Balance
Rent / House Payment
Car Payment(s)
Personal Loan(s)
School Loan(s)
Payroll Loan Payment(s)
Minimum Payment for Credit Cards
Other (Child Support, Alimony, etc.)
** NOTE: Do NOT count installment loans with 10 payments or less until payoff.
Agreement
I / We understand that this form is not an official application for a mortgage, but for pre-qualification purposes only.
I / We understand that CTX Mortgage will verify the information in this form.
I / We authorize CTX Mortgage to obtain a credit report on all borrowers named herein.
I / We acknowledge that nothing herein is to be considered a loan approval or guarantee of a loan or a guarantee of rates or terms.
Acceptance
Accept by typing "ACCEPT" (must be uppercase) in the field beside Borrower and Co-Borrower (if applicable).
Borrower Acceptance:
Co-Borrower Acceptance:
© 2005 Al Coker & Associates