Referral Mortgage, Inc.

Prequal Request

Fill out the following information to submit a Prequal Request at no cost. RMortgage.com provides fast mortgage approvals with our online residential application. There is absolutely no obligation for this free service. Your application will receive top priority and immediate attention. By completing the following questions about yourself we will be able to begin the loan process. Your answers will give us a better understanding of your needs and desires so that we can tailor make a loan just for you!

Privacy Promise: We DO NOT sell, lease, or share your information with anyone.

Borrower(s) Information *All fields in Red are required*

Borrower First & Last Name:

Borrower Social Security Number:

Co-Borrower First Name:

Co-Borrower Last Name:

Co-Borrower Social Security Number:

or, have RMortgage call to obtain Social Security Numbers

Mailing Address:

City:

State:

Zip:

Contact Phone:

Alt. Phone:

Fax Number:

Email Address:

Best time to contact you:

Property Information

Owner Type:

Property Type:

Is Property Address the same as above Mailing Address?

Yes

Property Address:

City:

State:

Zip:

Property Value or Purchase Price:

Do you have a current appraisal?

Yes No

Yearly Property Taxes $ Yearly Insurance Premium $ Monthly HOA Fee $

Loan Request Information

Request Type:

Loan Term:

Loan Type:

Loan Amount: $20,000 minimum

Do you have a Purchase Contract?

YesNo

Employment Information

Borrower Yearly Gross Income:

Is Borrower Income Verifiable?

Yes No

Borrower Years at Job:

Borrower Work Phone:

Borrower Are you self employed?

Yes No

Borrower Position/Title:

Co-Borrower Yearly Gross Income:

Is Co-Borrower Income Verifiable?

Yes No

Co-Borrower Year at Job:

Co-Borrower Work Phone:

Co-Borrower Are you self employed?

Yes No

Co-Borrower Position/Title:

Asset & Debt Information

Asset & Debt information completed as:

Jointly Not Jointly

Asset Cash Total: (checking,savings,money markets,CD's)

Asset Stock, Bond & Mutual Fund Total: (non IRA, 401k)

Asset Retirement Account Total: (IRA, 401K, Pensions)

Asset Other:

Monthly Debt*:

*car payments, credit cards, alimony or child support etc...

(DO NOT include rent or mortgage payment)

Describe your credit:

Refinancing Information (Complete only if Refinancing)

If Refinancing, Year Purchased:

If Refinancing, Purchase Price:

If Refinancing, Current Mortgage Balance: (1st Mortgage)

If Refinancing, Current Monthly Payment: (1st Mortgage)

PI PITI

Current Interest Rate of Existing 1st Mortgage: (%)

Existing 1st Mortgage Loan Term:

years

Existing 2nd Mortgage?

Yes No

If Refinancing, Current Mortgage Balance: (2nd Mortgage)

If Refinancing, Current Monthly Payment: (2nd Mortgage)

Current Interest Rate of Existing 2nd Mortgage: (%)

Existing 2nd Mortgage Loan Term:

years

Date you financed 2nd Mortgage:

Other Information