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10250 SW Greenburg Road, Suite 112
Portland Oregon 97223
(503) 245-7780

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Pre-Qualify
Note: The fields in Bold are the required fields
Your Information
First Name:
Last Name:
SSN:
Birthday:
Cell:
Work:
 Home:
 Applicants Married?
Yes No
Fax:
eMail:
  
Address:
City:
State:
ZipCode:
Purchase
Closing Date:
Purchase Price/Market Value:
Address:
City:
State:
ZipCode:
Down Payment:
%
From:
Equity Savings Gift Other
Refinance
1st Mortgage
 
Date:
Balance:
$
Interest Rate:
%
Monthly pmt: $
Insurance: $
Taxes: $
Other: $
Total: $
2nd Mortgage
 
Date:
Balance:
$
Interest Rate:
%
Monthly pmt: $
Insurance: $
Taxes: $
Other: $
Total: $
Income
Borrower
Base:
$
Rental:
$
Other:
$
Total:
$
Employed past 2 years:
Yes No
Same line of work:
Yes No
Self-employed:
Yes No
Co-Borrower
Base:
$
Rental:
$
Other:
$
Total:
$
Employed past 2 years:
Yes No
Same line of work:
Yes No
Self-employed:
Yes No
Comments
I/We have completed a Pre-Qualification request for a mortgage loan from Pacific Mortgage. As part of my/our Pre-Qualification, Pacific Mortgage may verify the information contained in the Pre-Qualification Request, in conjunction with a credit report, obtained for the purpose of verifying debt and/or credit history.

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