Pre-Qualification Application




Lead Information

Currently working with Loan Officer?
How did you hear about Cousins?

Contact Information

Borrower Information
Borrowers Name?
First
Middle
Last
Borrowers Address?
Street
City
State
Zip
How long at this address?
What is your Social Security number
and Birth Date?
SSN# DOB
Telephone numbers?
Home
Work
Cell
Co-Borrower Information (If any)
Co-Borrowers Name?
First
Middle
Last
Co-Borrowers Address?
Street
City
State
Zip
How long at this address?
What is your Social Security number
and Birth Date?
SSN# DOB
Telephone numbers?
Home
Work
Cell

Employment Information

Borrower
Self Employed? Emp Since
Employer:
Title:       
Gross Monthly Income: $
Overtime: $
Bonuses: $
Commissions: $
Other: $
Co-Borrower
Self Employed? Emp Since
Employer:
Title:       
Gross Monthly Income: $
Overtime: $
Bonuses: $
Commissions: $
Other $

Asset & Liability Information

Borrower
Checking: $
Savings: $
CDs/Stocks/Bonds: $
401K's/IRAs: $
Co-Borrower
Checking: $
Savings: $
CDs/Stocks/Bonds: $
401K's/IRAs: $

Combined Monthly Liabilities

Type Monthly Payment Unpaid Balance
Credit Cards: $ $
Auto Loans: $ $
Other Loans: $ $
Child Support: $

Property Information

Property address?
Street:
City:
State:
Zip:

Number of units:
Occupancy type:
Estate Held:
Property Value: $
Mortgage Type
Type of mortgage loan?
Purpose of this loan?
If you selected "Refinance", what is the purpose?
If you selected "Other", please explain.
Loan Information
Desired loan amount?
$
Estimated purchase price?
$
Estimated down payment amount?
$
If refinance, total owed on home?
$
Length of your requested loan in months?
Amortization Type:

Other Information

Which describes your current status?
I have found a realtor. Additional Comments:
Agents Name:
Company:
Phone Number:
I need a realtor, please have one contact me.
Best time to call: Morning Afternoon Evening

I/We (borrower[s] named herein) understand that this form is for pre-qualification only and is not an application.
Authorization to check credit verification
YES - Please check my credit
No - Do not check my credit
By selecting "YES" to this radio button, I/WE hereby authorize Cousins Home Lending to order a consumer credit report to verify credit and other information pertaining to pre-qualification. The information that Cousins Home Lending obtains is only to be used for mortgage pre-qualification purposes.
Email Address:
CoBorrower Email: