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:     

Amount in IRA’s or Retirement Funds:     

Auto Loans

Auto loans

Account no.

Balance

Monthly payment

Other Loans, Debts, or Obligations

Description

Account no.

Amount

These Questions apply to Both Borrower and Co-Borrower Pleas answer Yes/No

Are there any outstanding Judgments against you:      

Have you declared Bankruptcy in the past 7 years:      

Have you ever had property Foreclosed upon or given title or deed in lieu thereof in the past 7 years:      

Are you a US Citizen:      

Are you presently delinquent in any Federal debt or any other loan, mortgage, financial obligation, or bond:      

Have you had an ownership interest in a property in the last 3 years? If so was it a primary, secondary or investment home? If so did you hold it solely by your-self, jointly with a spouse or jointly with another person:

Are you obligated to pay child support, alimony, or separate maintenance:      

INFORMATION RELEASE AUTHORIZATION

   I authorize Charles Rutenberg Financial Services, Inc. to share with the party(ies) named below the content of any report or other statement regarding; (1) my current and past credit, employment and earnings; (2) my assets and liabilities; and (3) any other of my personal data having an affect upon my ability to obtain a loan approval.  I understand this does not authorize Charles Rutenberg Financial Services, Inc. to physically disseminate original documents or copies thereof to any person including the person named below.

   I understand that this information may be used to determine my eligibility for consideration of mortgage financing and is in no way to be construed as a commitment from Charles Rutenberg Financial Services, Inc. for that financing.

Signature of applicant:      

Date:      

Signature of co-applicant, if for joint account:      

Date: