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    Prequalify
    Borrower Information:
     
    Borrower (Full Name):
    Date of Birth: (ex. dd/mm/yyyy)
    Soc. Security #:
    Residence Phone #:
    Business Phone #:
    Present Address:
    City:
    State/Province:
    Zip Code/Postal Code:
    E-mail Address
    Years at Present Address:   Rent $ /month
    or Own $
     
    Previous Address:
    City:
    State/Province:
    Zip Code/Postal Code:
    Marital Status: Married
    Separated
    Unmarried (including single, divorced, or widowed)
      
    Occupation:
       (Position & Title)
    # of years:
    Place of Employment:
      (Name & Address)
    Previous Employer:
       (Name & Address)
    Co-Borrower Information:
     
    Co-Borrower (Full Name):
    Date of Birth: (ex. dd/mm/yyyy)
    Soc. Security #:
    Residence Phone #:
    Business Phone #:
    Present Address:
    City:
    State/Province:
    Zip Code/Postal Code:
    E-mail Address
    Years at Present Address:     Rent $  /month
    or   Own $ 
     
    Previous Address:
    City:
    State/Province:
    Zip Code/Postal Code:
     
    Marital Status: Married
    Separated
    Unmarried (including single, divorced, or widowed)
     
    Occupation:
       (Position & Title)
    # of years:
    Place of Employment:
       (Name & Address)
    Previous Employer:
       (Name & Address)
    Gross Annual Income:
     
    Borrower Co-Borrower
    Self-Employed ? Yes    No Yes    No
    Base Salary: $ $
    Overtime: $ $
    Bonuses: $ $
    Commissions: $ $
    Dividends: $ $
    Net Rental Income: $ $
    Other: $ $
     
    Total: $ $
     
    Do You Intend To Occupy This Property ?    Yes     No
    Number of Children:
    Ages:
    Other Dependents:
     
    Assets:
      Other Assets (Specify):
    Checking: $  Bank:
    $  Bank:
    Savings: $  Bank:
    $  Bank:
    Credit Union: $  Bank:
    Stocks: $
    Bonds: $
    Life Insurance: $
     
    Present Residence  (If Owned):
    Market Value: $
    Morg. Value: $
    Lender:
     
     
    Liabilities:
     
    (List outstanding obligations including auto loans, mortgage payments,credit cards,
    personal loans, and all other loans.)
     
    Type Creditor's Name Unpaid Balance Due Date Monthly Payment
    $ $
    $ $
    $ $
    Total:   $ $
     
    Additional Monthly Obligations:
    Alimony:  $
    Child Support:  $
    Child Care:  $
     
    Are There Any Judgements or Lawsuits Present?   Yes    No
    Amount:  $
    Is Any Part of the Down Payment or Settlement Costs
    Being Obtained From a Source Other Than From Assets
    Listed Above?     		  Yes    No
    I hereby give my consent to have my credit report secured
    from any credit reporting agency which you designate.     		  Yes    No


    Robert C. Lages, P.A. CDPE
    Real Living All Florida Realty
    Michele Beth Payuk CDPE Cell # 772-979-2199, 1648 SE Port St. Lucie Blvd., Port St. Lucie, FL 34952
    Toll Free: 1-866-873-5289 Ext 125 or 140
    Phone: (772) 335-1995 Ext 125 or 140
    Cell: (772) 529-3290
    Fax: (772) 335-3467
    © Copyright 2010 Robert C. Lages, P.A. CDPE, Real Living All Florida Realty Powered By AgentDeluxe.com