Borrower Name Co-Borrower
Address Address
City/State/Zip City/State/Zip
Social Sec. No. Social Sec. No.
Phone Phone
Cell Cell
Email Email
Employment Information
Borrower Co-Borrower
Employer Employer
Job/Title Job/Title
Years There Years There
Provide employment for the last 2 years. Use this box to provide additional employer information if the above is for less than 2 years.
Monthly Income (Gross) Monthly Expenses (Loans, Credit Accounts)
Borrower Co-Borrower Mo. Payment Balance
Base Monthly Wages Mortgage/Rent
Commissions Child Support
Bonuses Total
Overtime FUNDS AVAILABLE FOR DOWN PAYMENT, CLOSING COSTS ETC.
Other Deposit Accts Investments
Total Monthly Income Other Sale of Home
Authorization:
I (We) hereby give our authorization for BankSource Mortgage and any credit reporting agency or bureau which they designate, to obtain any and all information concerning our employment, deposit accounts, investment accounts, obligations and all other credit matters which they may require in connection with this Pre-Qualification request. Furthermore, it is hereby stated that an electronic copy of this Authorization shall be as effective as the original executed document. My (Our) agreement to the above stated Authorization is evidenced by the electronic submission of this form by clicking the below "Submit" button.
