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    Lot Loan Pre-Qualification

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Fields in Red are required to process your loan application.
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Borrower Information
How Did you Hear about Us?
Enter Discount Code
What Type Of Loan Do you Need?
Borrower   Co-Borrower  
Date of Birth Date of Birth
SS# SS#  
US Citizen Yes No US Citizen Yes No
Email Email
Cell Phone   Cell Phone 
Home Phone Home Phone
Work Phone  Work Phone
Current Address Current Address
City City
State State
Zip Code Zip Code
Years at Address Years at Address
Best Time To Reach Me: Best Time To Reach Me:
Please Contact Me By:    Phone E-mail Please Contact Me By:    Phone E-mail
Property Information
Property Type
Property Address
City
State
Zip Code
Nearest Major City
How Many Properties Do You Currently Own?
Does the Property Have Drinkable Water Yes No
Does the Property Have Septic Approval Yes No
Do You Own the Property Yet Yes No  Under Contract
Number of Acres
Land Purchase Price $
When Did You Buy the Property
Current Market Value $
Balance Outstanding $
Loan Amount Requested $
Is Any of Your Down Payment Borrowed Yes No  
How Much Down Payment Do You Have $
Employment Information
Borrower  Co-Borrower 
Self
Employed		   Yes No  Self
Employed		   Yes No 
Employer   Employer  
Employer
  Address		 Employer
  Address
Employer
 City, ST  Zip		 Employer
City, ST  Zip
Years at Job Years at Job  
Position Position  
Gross Salary Gross Salary  
Per Per
Hour Worked Per Week Hour Worked Per Week
Commission $ Commission $
Bonus $ Bonus $
Assets & Liabilities
Bank Name
Account Number
Current Balance
Mortgage Lender / Landlord
Monthly Mortgage Payment (include PITI) $
Current Balance $
Other Asset(s)
401K, IRA, Mutual Funds, Investments
Value $
Other Asset(s)
Value $
Automobiles
Make / Model   Year  
Lender  Monthly Payment
Method     Own Purchase  Lease Balance  
Make / Model   Year  
Lender  Monthly Payment
Method     Own Purchase  Lease Balance  
Credit Cards
Bank Name   Bank Name  
Payment Payment
Balance   Balance  
Bank Name   Bank Name  
Payment Payment
Balance   Balance  
Credit History
Have you had a foreclosure?  Yes No  
Do you have any outstanding judgments?  Yes No  Amount $
Have you had a bankruptcy?  Yes No Type
Year Discharge Date
Are you obligated to pay alimony and/or child support?   Yes No Monthly Amount $
Do you receive alimony and/or child support?   Yes No Monthly Amount $
Have you had difficulty with credit or ever filed for bankruptcy in the last 10 years?   Yes No
If yes, please explain:
Authorization to Release Credit Information
I authorize  Eagle Nationwide Mortgage Company and/or assigns to obtain my/our credit report and/or any additional individual information to determine credit worthiness.  The information that is obtained is strictly confidential.  A photocopy or facsimile of this authorization may be deemed to be the equivalent of the original.  This Pre-Qualification is not a loan application.  Your loan application will begin upon receipt of a signed 1003 loan application and disclosures.
Borrower  Co-Borrower 
I agree to Credit Authorization
 Agree Disagree 		 I agree to Credit Authorization  
Agree Disagree 
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