Pre-Qualification Form

Full Name

Address

Assets

Semi-liquid assets -- Stocks, bonds, cd's or other securities.

Dollar value -- Real estate for sale (if any).

Dollar value -- Any other real estate.

Projected assets to be received-- If you expect to receive a gift from a relative, an inheritance, an insurance settlement or other monies please indicate the dollar value and a brief description of the source.

Income

Have you received a steady income from this source for
Less than two years
More than two years

Annual Base Income -- Enter the dollar amount of your annual base income. (Please do not include any overtime, bonuses, or other income here.)

Other Income -- Enter the dollar amount of any other income and a brief description of where it comes from (overtime, second job, dividends, interest, social security, pension plan, etc.).

Please enter any other individual's name you wish to consider in your plan, and their relationship to you (husband, wife, mother, etc.).

Their income is derived from Salary (W2 Income) Hourly Wages (W2 Income) Self Employed (bottom-line from Schedule C) Other

Has your co-person received a steady income from this source for
Less than two years
More than two years

Annual Base Income -- Enter the dollar amount of your co-person's annual base income. (Please do not include any overtime, bonuses, or other income here.)

Other Income -- Enter the dollar amount of any other income and a brief description of where it comes from (overtime, second job, dividends, interest, social security, pension plan, etc.).

Is there anything else relevant to income?

Liabilities

Monthly minimum required credit card payments (Even if you pay all credit cards in full each month, try to add together the "minimum payments" required by each company).

The balance on any mortgage to be paid-off.

The monthly payment (including taxes, insurance, mortgage insurance, association fees) on any mortgage that will not be paid-off.

Any other monthly installment debt or court ordered obligations (like personal loans, child support, etc.)

Thank you for supplying us with this information. It will allow us to work as a team to devise a solid plan for your immediate and longer term goals. Please press the "submit" button. We will contact you as soon as possible.

Do you prefer to be advised of the results via:
Email?
Your e-mail address

Phone?
Your phone number

Thank you.