NOTE: This is not a loan application and is used for
 prequalification purposes only.

 

This form uses SSL encryption for your security. However, you may also pre-qualify by fax. Download our Prequalification Form and Fax to (251) 445-5527 (attention: Blake). (Get Adobe Acrobat Reader)

Use the form to begin the process of applying for your loan.
When we have received this information, we will contact you
 to discuss the best loan options for your situation.

 

 

Borrower:
 

  

Co-Borrower:
 
Name:     Name:
Date of Birth:   Date of Birth:
SS#:   SS#:
Address:     Address:
     
City:     City:
State:     Zip:            State:    Zip:   
E-mail:     Email:
Own    Rent      No. Yrs.    Own      Rent       No. Yrs. 
        Rent Paid by:    Cash   Check          Rent Paid by:    Cash   Check
Home Phone:     Home Phone:
Cell Phone:   Cell Phone:
  Married   Unmarried (includes single, divorced, widowed)   Separated

Employment Information:

Self Employed:   Self Employed:
Position / Title & Type of Business:   Position / Title & Type of Business:
 
Years on this job:     Years on this job:  
Years in this profession:     Years in this profession:  
Name & Address of Employer:   Name & Address of Employer:
 
 
 
Work Phone:               Work Phone:           
Gross Monthly Income:   $   Gross Monthly Income:  $
Other Income:                   $   Other Income:                  $
Source of other income:   Source of other income:
 

Asset Information:

Name of Bank:
Address of Bank:
Account Number: Balance: $
   
Name of Bank:
Address of Bank:
Account Number: Balance: $
   
Name of Bank:
Address of Bank:
Account Number: Balance: $
   
Stocks & Bonds (Company Name, Account Number & Description):
  Item #1:
  Item #2:
  Item #3:
  Item #4:


Real Estate Owned:

 

Property Address:

 Present Market Value Mortgage
Amount 		Gross Rental Income Mortgage Payments Type of Property
$ $ $ $
$ $ $ $
$ $ $ $

Automobiles Owned:

Make: Year: Value: $
Make: Year: Value: $
Make: Year: Value: $

Subject Property Information:

Address:     
City:              
State:              Zip:
Amount of Mortgage Applied For:     $
No. of Months Applied For:                   

Choose on of the following from each row:
Purchase Refinance Construction
Primary Residence Secondary Residence Investment Property
     

Refinance Information:

Year Home Was Acquired: 
Purpose of Refinance:    Rate / Term     Cash Out     Debt Consolidation

Personal / Financial Information Release Authorization:

  I / We hereby authorize the release of any personal and / or financial information requested by Blake Felts, Broker / Owner, Exit Realty Partners. as specified below:

  • Employment and Income Verification

  • Checking and Savings Deposit Verification

  • Mortgage Loan Balances and Payment History

  • Consumer Credit Balances and Payment History

  • Any other pertinent personal or financial information

Additional Questions or Comments: