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					How

qualify for?
Face-to-Face Telephone

much I can
Gross Annual Income Applicant Co-Applicant
Base $______________ $______________ Bonuses/overtime* $______________ $______________ Commissions* $______________ $______________ Dividends/interest* $______________ $______________ Other* $______________ $______________ TOTAL $______________ $______________ Source of other income:_________________________________________
*Average of last two years (Note: Alimony, child support or separate maintenance income need not be revealed if you do not choose to have it considered for prequalification purposes.)

Applicant’s Name:___________________________________________ Date of Birth:____________________ SSN: _______________________ Home Phone: _________________________________________________ Work Phone: __________________________________________________ Applicant’s Present Address: _____________________________________________________________ _____________________________________________________________ Employer: ____________________________________________________ Position: ______________________________________________________ Co-Applicant’s Name: _______________________________________ Date of Birth:____________________ SSN: _______________________ Home Phone: _________________________________________________ Work Phone: __________________________________________________ Applicant’s Present Address: _____________________________________________________________ _____________________________________________________________ Employer: ____________________________________________________ Position: ______________________________________________________
Preferred type of mortgage: _____________________________________ Anticipated down payment:_____________________________________ Who referred you to Platinum: __________________________________ Do you have any outstanding judgements? No Yes Have you filed for bankruptcy in last 7 years? No Yes Have you owned any real estate in last 3 years? No Yes

Liabilities
Mortgage/rent Other real estate Installment (autos) Installment (other) Revolving charges Revolving credit Alimony/maintenance Child care/support Other TOTAL

Monthly
$______________ $______________ $______________ $______________ $______________ $______________ $______________ $______________ $______________ $______________

Balance
$______________ $______________ $______________ $______________ $______________ $______________ $______________ $______________ $______________ $______________

Assets/Other
Checking/savings Stocks/bonds Equity in real estate Gi funds Other TOTAL $______________ $______________ $______________ $______________ $______________ $______________

I/we acknowledge and agree that this application is for prequalification purposes only and that the information provided in this application along with an in-file credit report, if deemed necessary, are the only criteria that will be used to evaluate my/our prequalification status. I/we further agree that upon my/our request Platinum Home Mortgage will begin a formal mortgage loan application for a specific property and loan amount. Applicant’s Signature: _____________________________ Date: ____________ Co-Applicant’s Signature: _________________________ Date: ____________

Loan o cer certifies to Platinum Home Mortgage that the information contained in this application was obtained in person or by telephone directly from one or both of the applicants listed above. Loan o cer further certifies that the information provided for this application along with an in-file credit report, if deemed necessary, are the only criteria that will be used to evaluate the applicant/s’ prequalification status and that upon request from the applicant/s the loan o cer will begin a formal mortgage loan application for a specific property and loan amount. Loan O cer’s Signature: ___________________________ Date: ____________

For more information please contact:

Steve Carrigan
Office: 805 389-0282 ext 206 Fax: 805 389-0292 Email: Steve@cfgteam.com Office Address: 771 Daily Drive, Suite 120 Camarillo, CA 93010
Information subject to change without notice. All loans subject to credit approval. Platinum Home Mortgage Corporation is a Florida, Illinois, Indiana, Michigan, Texas, Washington, and Wisconsin Residential Mortgage Licensee. Licensed by the Department of Corporations under the California Residential Mortgage Lending Act. Platinum Home Mortgage Corporation, Corporate Headquarters, 2200 Hicks Road, Suite 101, Rolling Meadows, IL 60008, 847-797-9500. Please see our website for additional licensing information. Prequal Form01 - 10/24/07

www.platinumhomemortgage.com


				
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posted:5/11/2009
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