Pre-Qualification Form Name First Last PhoneEmail Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Loan InformationLoan PurposePurchaseRefinanceProperty TypeSingle FamilyCondoMobile/ManufacturedHome ValueUnder $100,000$100,000 — $125,000$125,000 — $150,000$150,000 — $175,000$175,000 — $200,000$200,000 — $250,000$250,000 — $300,000$300,000 — $350,000$350,000 — $400,000$400,000 — $450,000$450,000 — $500,000$500,000 — $600,000$600,000 — $700,000$700,000 — $800,000$800,000 — $900,000$900,000 — $1,000,000Over $1,000,000Current Mortgage BalanceUnder $100,000$100,000 — $125,000$125,000 — $150,000$150,000 — $175,000$175,000 — $200,000$200,000 — $250,000$250,000 — $300,000$300,000 — $350,000$350,000 — $400,000$400,000 — $450,000$450,000 — $500,000$500,000 — $600,000$600,000 — $700,000$700,000 — $800,000$800,000 — $900,000$900,000 — $1,000,000Over $1,000,000Additional Cash RequestNone$5,000 — $10,000$10,000 — $15,000$15,000 — $20,000$20,000 — $25,000$25,000 — $30,000$30,000 — $35,000$35,000 — $40,000$40,000 — $45,000$45,000 — $50,000$50,000 — $55,000$55,000 — $60,000$60,000 — $65,000$65,000 — $70,000$70,000 — $75,000$75,000 — $80,000$80,000 — $85,000$85,000 — $90,000$90,000 — $95,000$95,000 — $100,000Over $100,000Credit ProfileExcellentGoodFairPoor