Mortgage Loan Pre-Qualification Form

							               Mortgage Loan Pre-Qualification Form
                                                  Statewide Bank
Page 1 of 2



           Mortgage Information                                      Co-Applicant Information


Sale Price $                                                  Name



Loan Amount $                                                 Social Security #


           Applicant Information
                                                              Marital Status              DOB


Name
                                                              Home Phone                  Work Phone


Social Security #
                                                              Fax Number                  Email Address


Marital Status              DOB
                                                              Current Address


Home Phone                  Work Phone
                                                              City                State                Zip


Fax Number                  Email Address
                                                              Position                    Start Date


Current Address
                                                              Gross Monthly Income


City                State                Zip                                Personal Assets
                                                                         (Applicant & Co-Applicant)


Own                 Rent          Since (mo/yr)
                                                              Financial Institution


Current Employer
                                                              Account Type                Balance


Address
                                                              Financial Institution


City                State                Zip
                                                              Account Type                Balance


Position                    Start Date
                                                              Financial Institution


Gross Monthly Income
                                                              Account Type                Balance
               Mortgage Loan Pre-Qualification Form
                                                 Statewide Bank
Page 2 of 2




Financial Institution



Account Type              Balance


                 Obligations


Car Payments $



Installment Loans $



Credit Cards $



Other $


With Your Signature, We're On It.

With your signature and your co-applicant's (if necessary),
we can quickly process your pre-qualification form.

I hereby authorize Statewide Bank to verify my past and present
employment earnings records, bank accounts, stock holdings, and
any other asset balances that are needed to process my mortgage
loan pre-qualification form. I further authorize Statewide Bank
to order a consumer credit report and verify other credit information,
including past and present mortgage and landlord references. If your
intent is to apply for joint credit, both applicants must sign.




Applicant



Co-Applicant




Member FDIC