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Please complete as much of this information as you can so that we can give you better feedback.

Borrower Name: Age SS# 
Co-Borrower Name: Age SS# 

RESIDENCE FOR LAST 2 YEARS:
Current Address:  Street
City State Zip 		How Long?:
Previous Address:
(if current less than 2 yrs)		 Street
City State Zip 		How Long?:

EMPLOYER(S) FOR LAST 2 YEARS:
Borrower's Occupation
Borrower's Current Employer How Long?:
Borrower's Previous Employer How Long?:
Borrower's Gross Monthly Income: $
 Co-Borrower's Current Employer How Long?:
Co-Borrower's Occupation
Co-Borrower's Gross Monthly Income: $
EXPENSES: Rent or Home Payment $ per month
Total Auto Payments $ per month
Total Other Payments 
(credit cards, bank loans, etc.)		 $ per month
Total Monthly $

ASSETS: Present bank account, credit union, or brokerage account balances:
Checking $
Savings $
Stocks/Bonds $
Real Estate Owned $
Source of Down Payment
Real Estate Agent Name:
Agent Phone #:
Borrower's Phone:
Borrower's E-mail:
Co-Borrower's Phone: 
CO-Borrower's E-mail:
Best time to call me/us is:
When do you plan to relocate? 0-90 Days  91 days +
Please enter other comments:

By Clicking the Submit Data Button:
I request Evergreen Financial Services review my financial information for the specific purpose of predetermining my qualifications for a home mortgage. I understand that this information is confidential and I authorize Evergreen Financial Services to order a preliminary credit check for Pre-qualification ONLY.

I understand that this pre-qualification service is being performed at no cost to me and does not obligate me to any specific REALTOR® or mortgage company. Entry of real estate agent name above authorizes Evergreen Financial Services to discuss my credit and financial information with that agent only.

 

Evergreen Financial Services
10777 W. Twain Ave, Suite 105
Las Vegas NV 89135
Telephone: (702) 308-7112 FAX: (702) 974-2880