Richland Mortgage

The Home Loan Professionals

ON-LINE APPLICATION

Pre-Qualification Form

* Indicates Required Fields

Loan Purpose
Property will be in my
Number of Units
If re-financing, Year Purchased                                     Purchase Price  
Annual Property Taxes *   Annual Home Owners Insurance *  
   
Existing Loans on Property
1st Loan Balance    Interest Rate     Monthly Payment  
2nd Loan Balance    Interest Rate     Monthly Payment  

Subject Property Address
Street
City, State, Zip      
Property value *   $ 
Loan Amount *   $ 


Please complete the information below for the borrower and co-borrower (if any).
BORROWER CO-BORROWER
First Name & Middle Initial
 *  
   
Last Name *     
Home Phone (incl. area code) *     
Business Phone (incl. area code) *     
E-mail address *     
Present Address - Street *     
Present Address - City, State, Zip *     
Rent or Own? *       No. of years          No. of years  
Yrs. of employment at current job *    Years Employed     Years Employed
Yrs. employed in current line of work/profession *    Years Employed     Years Employed
Are you self employed? *     

Monthly Income Information ( * = Estimated )
Gross Annual Income* BORROWER CO-BORROWER
Base employee. Income*
Overtime
Bonuses
Commissions
Dividends/Interest
Rental Income
Other**
 
* Self Employed Borrower (s) may be required to provide additional documentation such as tax returns and financial statements.

** Notice: Alimony, child support, or separate maintenance income need not be revealed if the Borrower (B) or Co-Borrower (C) does not choose to have it considered for repaying this loan.

Please enter any comments or questions here:

May we perform a credit check? Yes No

If you selected yes to a credit check above, then please provide the borrower's date of birth (mm/dd/yyyy) *

If there is a co-borrower, then please provide the co-borrower's date of birth
(mm/dd/yyyy) *