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Mortgage Prequalification Form

Please fill out the entire form and press "Submit" to send your information to the bank via our secure server.  Asterisks (*) denote required fields. Thank you.  Any questions, feel free to contact us.
Mortgage  Information
Will there be a co-applicant on this application? *
Yes or No 
Amount requested *
Purpose *
Length of Loan *
Credit Type  * 

You may apply for individual or joint credit, but choose only one of the following.  Thank you.

Individual Credit - unmarried applicant
  Individual Credit - married applicant
  Joint Credit - with your spouse
  Joint Credit - with an applicant or cosigner who is not your spouse

Notice to married applicant:  No provision of any marital property agreement, a unilateral statement under Wis. Stat. sec 766.59 or a court decree under Wis Stat. sec 766.70 adversely affects the interests of the creditor unless the creditor, prior to the time the credit is extended, or an open-end credit plan is entered into,  is furnished with a copy of the agreement statement or decree, or has actual knowledge of the adverse provision when the obligation to the creditor is incurred.

Personal Information
First Name: *
Middle Initial:*
Last Name:*
Email Address:*  
Social Security Number:*
Marital Status:* Married
Unmarried
(includes single, widowed and divorced)
Birthdate:* (xx/xx/xxxx)
Address:*
   City:*
   State:*
   Zip:*
How Long?*
Home Phone Number, with area code:*
If you've lived at your current address less than 2 years, please provide your previous home address:
Previous Address:
   City:
   State:
   Zip:
How Long?

Employment Information
Work Phone Number:*
Employer:*
    Address:*
    City:*
    State:*
    Zip:*
Position:*
How Long Employed:
Salary per Month:
Source of other income
Note: Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Amount per month:

Joint or Other Applicant Information

If your mortgage application is for joint credit, or you are married and reside in a community property state, you must also fill out this section of the application.  If you are applying for individual credit, you can skip this section. 
First Name: 
Middle Initial:
Last Name:
Social Security Number:
Marital Status: Married
Unmarried
(includes single, widowed and divorced)
Birth date (xx/xx/xxxx)
Home Address:
   City:
   State:
   Zip:
How Long?
Home Phone Number:
If you've lived at your current address less than 3 years, please provide your previous home address:
Previous Home Address:
   City:
   State:
   Zip:

Employment Information
Work Phone Number:
Employer name:
    Address:
    City:
    State:
    Zip:
Position:
How Long Employed:
Salary per Month:
Source of other income:
Note: Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Amount per month:

Asset Information
Savings/Checking balance: *
Real Estate- locations, value:
Auto - year, make model:
Other Asset:
Other Asset:

Debt Information

List all debts and credit accounts, replacing "Other" with description. If those listed do not apply, please say "None" for  balance & payment..

Balance

Monthly Payment
Rent or Mortgage
Credit Card
Auto Payments

Property Information
Property Address:
   City:
   State:
   Zip:
Annual Property Taxes:
Annual condo/PUD fees:
Annual Hazard Insurance:

 

Information Requested by the Federal Government

Please complete this section only if you are applying for a term loan and any portion of the funds will be used to purchase or improve a home, or to refinance an existing loan that was used to purchase or improve a home. The following information is requested by the federal government for certain types of loans related to a dwelling. This information is used to monitor our compliance with equal credit opportunity, fair housing, and home mortgage disclosure laws. You are not required to furnish this information, but we encourage you to do so. The law provides that a lender may not discriminate on the basis of this information, nor on the way you wish to furnish it. If you choose not to complete this section, under federal regulations, we are required to note race or national origin and sex on the basis of visual observation or surname.
Applicant (A):
    I do not wish to furnish this information  

Race or National Origin:
   
    If you selected "Other" above, please specify:
Sex:

Co-Applicant (C):
    I do not wish to furnish this information  

Race or National Origin:
   
    If you selected "Other" above, please specify:
Sex:

 
Any comments or questions you may have for us?

 

By submitting this application, I/We certify that this information has been supplied truthfully, accurately and voluntarily, and therefore authorize <Institution Name>. to investigate our creditworthiness, credit history and financial responsibility through any credit bureau or by any other reasonable means for consideration for the loan applied for, or for any other services offered.  This application does not constitute a contract for the extension of credit.  

Thank You.  Upon receipt of this application, someone at <Institution Name> will review your information and get back to you to extend credit, with additional questions or to request  further information. We appreciate this opportunity to be your financial partner.

The CYFI Bank is not a real financial institution. This site is designed to showcase the services provided by CyFi. Copyright 2003 . All Rights Reserved.            

 

For questions or comments about this site, contact askcyfi@cyfi.com.  It  is not a real financial institution. This site is designed to showcase the services provided by Farin & Associates. Copyright 2004 . All Rights Reserved.           

(c) 2004 Farin and Associates, Inc. All rights reserved.