Pre-Qualification Form

By entering data in this form, I acknowledge and grant permission for a representative of Primary Residential Mortgage, Inc. to contact me regarding my home buying and financing needs.

The information you provide here will be used in determining the amount of mortgage for which you can qualify. This symbol indicates required information.
Name:
Co-borrower Name:
Address 1:
Address 2:
City:
State:
Zip:
Day Phone:
Night Phone:
Fax:
Preferred Call Time:
Email:
I want the...
Purpose of Loan:
Property Type:
Desired Loan Amount:
Cash Downpayment:
Loan-to-Value:
Original Purchase Price:
Monthly Payment:
Estimated Property Value:
Amount Owed on Current Property:
Interest Rate on Current Loan:
Credit:
Employer:
Years at Job:
Property State:
Property City:
Annual Property Taxes:
Annual Homeowners Insurance:
Annual Income:
Available Cash On Hand:
If this is for a refinance please tell us the number of years you expect to be in your house:
First Time Buyer? YES       NO
Have you already located a house? YES       NO
Are you using a realtor? YES       NO
Realtor's Name:
Realtor's Company:
Realtor's Phone:
Realtor's Email:

Additional Information
Please take a moment to tell us your goal for this loan. For example: "I'm looking for a 30-year fixed rate with the lowest down possible". This helps us in determining the best loan program for you:

This information is being used as a prequalification only and is not an application for credit. In connection with my prequalification, I authorize Primary Residential Mortgage, Inc. to do an in-file credit report if they so choose. By submitting this form, I agree to accept calls regarding mortgage services offered by PRMI.

Submitting this form does not obligate me to accept a loan should I be approved, and it does not constitute a rate lock with Primary Residential Mortgage, Inc., (PRMI). The information submitted will remain confidential and will only be used by PRMI to determine the best loan program for my needs.
                                                                                           
I choose not to have my information shared with third parties or affiliated companies, except as may be required for the purpose it was submitted and where required by state and federal law. Third parties and affiliated companies may include companies with whom PRMI has an established relationship to provide you with additional services or products.
 
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