Pre-Qualification For Mortgage, Charles Rutenberg Financial

Applicant Information

Name:     

Date of birth:     

SSN:     

Phone:     

Current address:     

City:     

State:     

ZIP Code:     

Own       Rent      

Monthly payment or rent:     

How long?     

Previous address:     

City:     

State:     

ZIP Code:     

Owned          Rented        

Monthly payment or rent:     

How long?     

Employment Information

Current employer:     

Employer address:     

How long?     

Phone:     

E-mail:     

Fax:     

City:     

State:     

ZIP Code:     

Position:     

Hourly            Salary

Annual income:     

Previous employer if less then 2 years at current employer:     

Address:     

How long?     

Phone:     

E-mail:     

Fax:     

City:     

State:     

ZIP Code:     

Position:     

Hourly           Salary

Annual income:     

Name of a relative not residing with you:     

Address:     

Phone:     

City:     

State:     

ZIP Code:

Relationship:     

Co-Applicant Information, if for a joint account

Name:     

Date of birth:     

SSN:     

Phone:     

Current address:     

City:     

State:     

ZIP Code:     

Own                  Rent      

Monthly payment or rent:     

How long?     

Previous address:     

City:     

State:     

ZIP Code:     

Owned          Rented         

Monthly payment or rent:     

How long?     

Employment Information

Current employer:     

Employer address:     

How long?     

Phone:     

E-mail:     

Fax:     

City:     

State:     

ZIP Code:     

Position:     

Hourly            Salary

Annual income:     

Previous employer if less then 2 years at current employer:     

Address:     

Phone:     

E-mail:     

Fax:     

City:     

State:     

ZIP Code:     

Position:     

Hourly           Salary  

Annual income:     

Application Information Continued

Married:                                            Separated:                                      Unmarried:

Number of Dependents:     

Ages:     

Assets

Name of Banks

Checking or Savings

Amount in Account

Notes

401k or Retirment Funds

401k Amount:     

Amo