Mortgage Prequalification Form

What are you looking for today?

Purchase

Refinance

Home Equity Loan

Borrower

First Name *

Middle Name *

Last Name *

Social Security *

Phone *

Date of Birth *

Marital Status

Single

Married

Borrower - continued

Years of School *

Age of Dependents (Separate ages with comma)

Employer *

Position/Title *

Business Phone *

Monthly Income *

Email *

Years on Job *

Years in Profession *

Self Employed?

Yes

No

Other Income

Present Housing

Present Street Address *

City *

ZIP Code *

Do You?

Own

Rent

How many years? *

Bankruptcy in the past 7 years?

Yes

No

Property Info

Estimated Sales Price

Down Payment Amount

Source

Real Estate Agent

By checking this box, I/We hereby authorize ANECA FCU to order a consumer credit report and verify other credit information, including past and present mortgage and landlord references. I/We further authorize ANECA FCU to verify past and present employment earnings records, bank accounts, stock holdings and any other asset balances needed to process this request. Is it understood that a copy of this form will also serve as authorization. The information ANECA FCU obtains is only to be used in the processing of this request.

Print Name *

Do you have a Co-Borrower?

Yes

No

Co-Borrower

Co-Borrower First Name

Co-Borrower Middle Name

Co-Borrower Last Name

Co-Borrower Social Security

Co-Borrower Phone

Co-Borrower Date of Birth

Marital Status

Single

Married

Co-Borrower - continued

Years of School

Age of Dependents (Separate ages with comma)

Co-Borrower Employer

Co-Borrower Position/Title

Co-Borrower Business Phone

Co-Borrower Monthly Income

Co-Borrower Email

Co-Borrower Years on Job

Co-Borrower Years in Profession

Self Employed?

Yes

No

Co-Borrower Other Income

By checking this box, I/We hereby authorize ANECA FCU to order a consumer credit report and verify other credit information, including past and present mortgage and landlord references. I/We further authorize ANECA FCU to verify past and present employment earnings records, bank accounts, stock holdings and any other asset balances needed to process this request. Is it understood that a copy of this form will also serve as authorization. The information ANECA FCU obtains is only to be used in the processing of this request.

Print Co-Borrower Name

Demographic Information of Borrower

The purpose of collecting this information is to help ensure that all applicants are treated fairly and that the housing needs of communities and neighborhoods are being fulfilled.

For residential mortgage lending, Federal Law Requires that we ask applicants for their demographic information (ethnicity, sex, and race) in order to monitor our compliance with equal credit opportunity, fair housing, and home mortgage disclosure laws.

You are not required to provide this information, but are encouraged to do so. You may select one or more designations for "Ethnicity" and one or more designations for "Race." The law provides that we may not discriminate on the basis of this information, or on whether you choose to provide it.

However, if you choose not to provide the information and you have made this application in person, Federal regulations require us to note your ethnicity, sex, and race on the basis of visual observation or surname. The law also provides that we may not discriminate on the basis of age or marital status information you provide in this application. If you do not wish to provide some or all of this information, please check below.

Ethnicity

Hispanic or Latino

Mexican

Puerto Rican

Cuban

Not Hispanic or Latino

I do not wish to provide this information

Other Hispanic or Latino - Print Origin

Other

Race

American Indian or alaska Native - Print name of enrolled or principal tribe:

Name

Asian

Asian Indian

Chinese

Filipino

Japanese

Korean

Vietnamese

other asian - Print race:

Race

Black or African American

Native Hawaiian or other Pacific Islander

Other Pacific Islander

Native Hawaiian

Guamanian or Chamorro

Samoan

White

I do not wish to provide this information

Thank You