Michael and Shelly Kelly On-Line Prequalification

Michael and Shelly Kelly

On-Line Loan Prequalification

Phone: 512.636.5955

Fax: 512.610.5097

www.michaelandshellykelly.com

Are you currently working with an agent? YesNo

If yes please select their name here

Borrower Information

Borrowers First Name: MI: Last Name:

Date of Birth: Social Security #: Marital Status:

Home Phone: Cell Phone: Work Phone:

Address: City: State: Zip

E-Mail Address:

Do you pay Child Support:? If YES how much per month?

Co-Borrower Information

First Name: MI: Last Name:

Co-Borrower Relationship to Borrower:

Date of Birth: Social Security #: Marital Status:

Home Phone: Cell Phone: Work Phone:

Address: City: State: Zip

E-Mail Address:

Do you pay Child Support:? If YES how much per month?

What is your rent Payment: Mortgage Payment Desired:

Borrower's Employer	Co-Borrower's Employer
Current Employer:	Current Employer:
Are you self employed YesNo	Are you self employed YesNo
Type of Business:	Type of Business:
Position: Length of time :	Position: Length of time:
Monthly Income (before taxes):	Monthly Income (before taxes):
How much do you make per hour?	How much do you make per hour?
How many hours per week do you work?	How many hours per week do you work?
Are taxes taken out of your paycheck?	Are taxes taken out of your paycheck?
Do you receive child support?	Do you receive child support?
If YES how much per month?	If YES how much per month?

Please type in any comments you wish to send.

I hereby authorize the All Homes Team At Land Mortgage to perform a credit check:YesNo

Mortgage Banker #43954

This application is subject to verification of all the information furnished above and the review of a credit report.