Good • Poor • Slow • Bad Credit - OK You Can Be A Home Owner Georgia Residential Mortgage License "Flexible Lending To Fit Your Income & Needs" 810 Ridgeway Drive • Valdosta, Ga 31602 (912) 242-8452 • 1-877-HOME44 • Fax: (912) 247-8680

Pre-Qualification:
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Source: TV Radio AD/WHOS' TELBK Agent Date Borrower: Name Ph# Hm Address City St Zip SSN# DOB Employer Ph# Wk Address City St Zip Position Time on Job Monthly Income$ Co-Borrower: Name Ph# Hm Address City St Zip SSN# DOB Employer Ph# Wk Address City St Zip Position Time on Job Monthly Income$ Type of Loan: 1st 2nd H/I B/C N/P REF Loan Amount$ Interest Rate Subject Property Address MV LB LTV % 1st Mtg Bal Pmt 2nd Mtg Bal Pmt Any Bankruptcies: Yes No When Any Foreclosures: Yes No When Property Description: No. Stories Total Rms Bedrms Baths Basement Full Finished Brick Frame Garage Attached Detached 1Car 2Car When Did You Purchase Your Home Purchase Price $ Credit Rate: (A-D) DTI (%) Liabilities: Borrower Signature Authorization Privacy Act Notice: This information is to be used by the agency collecting it or its assignees in determining whether you qualify as a prospective mortgagor under its program. It will not be disclosed outside the agency except as required and permitted by law. You do not have to provide this information, but if you do not your application for approval as a prospective mortgagor or borrower may be delayed or rejected. The information requested in this form is authorized by Title 38, USC, Chapter 37 (if VA); by 12 USC, Section 1701 et. seq. (if HUD/FHA); by 42 USC, Section 1452b (if HUD/CPD); and Title 42 USC, 1471 et. seq., or 7 USC, 1921 et. seq. (if USDA/FmHA). Part I - General Information 1. Borrower(s) 2. Name and address of lender/Broker 3. Date 4. Loan Number Part II - Borrower Authorization I hereby authorize the Lendeer/Broker to verify my past and present employment earnings records, bank accounts, stock holdings, and any other asset balances that are needed to process my mortgage loan application. I further authorize the Lender/Broker to order a consumer credit report and verify other credit information, including past and present mortgage and landlord references. It is understood that a copy of this form will also serve as authorization. The information the Lender/broker obtains is only to be used in the processing of my application for a mortgage loan. Borrower Date Borrower Date Self Employed • Foreclosures • Bankruptcy - OK ACH Mortgage Company 810 Ridgeway Drive • Valdosta, Ga 31602 (912) 242-8452 • 1-877-HOME44 • Fax: (912) 247-8680 Welcome | About Us | Application Copyright © 1999 All Rights Reserved. Intelligent Media Ventures, Inc.