Please fill-out the following Lender Pre-Qualification Request Form. Based on the input one of my lenders receives from this form, you will have a good idea of how much house you can buy, various loan programs available to you and your estimated monthly payments. This information will be treated as confidential and will not be used for any other purpose.

Personal Info:   Name Address City State/Province -- Select --Outside U.S.Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip/Postal Country -- Select --Albania Algeria American Samoa Andorra Angola Anguilla Antigua Argentina Armenia Aruba Australia Austria Azerbajan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire Bosnia & Herzegovina Botswana Brazil Brunei Bulgaria Burrkina Faso Burundi Camaras Cambodia Cameroon Canada Canary Islands, The Cape Verde Caroline Island Cayman Islands Central African Republic Chad Chile China, People's Republic Colombia Congo Congo, The Democratic Republic Cook Islands Costa Rica Cote D'Ivoire Croatia Cuba Curacao Cyprus Czech Republic, The Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt Eire El Salvador Equatorial Guinea Eritrea Estonia Ethopia Falkland Islands Faroe Island Fiji Finland France French Guiana Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Republic Guinea-Bissau Guyana (British) Haiti Honduras, Republic Hong Kong Hungary Iceland India Indonesia Iran Ireland, Northern (UK) Ireland, Republic Of Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, DPR (North Korea) Korea, Republic Of Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxemburg Macau Macedonia, Republic Of Macronesia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Moldova, Republic Of Monaco Mongolia Montserrat Morroco Mozambique Myanmar Namibia Nauru, Republic Of Nepal Netherlands, The Nevis New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines, The Poland Portugal Puerto Rico Qatar Reunion, Island Of Romania Russian Federation, The Rwanda Saipan Sao Tome and Principe Saudi Arabia Scotland (UK) Sengal Seychelles Sierra Leone Singapore Slovakia Slovania Solomon Islands Somalia South Africa Spain Sri Lanka St. Barthelemy St. Eustatius St. Kitts St. Lucia St. Maarten St. Vincent Sudan Suriname Swaziland Sweden Switzerland Syria Tahiti Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Of America Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands (British) Virgin Islands (US) Western Samoa Yemen Yugoslavia Zambia Zimbawe Day Phone Evening Phone Fax Email Currently Rent or Own? Own Rent Property Type to Buy: (select all applicable) Residential Commercial Land Investment Your Information:   Your gross monthly income Your spouse's monthly gross income Other monthly income Alimony Monthly Income Monthly Minimum Credit Card Payments for All Persons on This Loan Monthly Auto Payments for All Persons on This Loan Alimony Monthly Payments Child Support Monthly Payments Other Monthly Regular Payments for Loans or Other Financial How Would You Rate Your Credit History? Choose Fair Excellent Good Poor Bankruptcy in Last 7 Years? No Choose Yes Currently Employed? No Choose Yes How Soon Do you Need This Loan? Do You Need A Real Estate Agent to Sell Your Home? No Choose Yes Do You need a Real Estate Agent to Help you Find a Home? No Choose Yes Comments: