Secure Online Pre-Approval Application Form
 Borrower Information
Borrower Name:
 Co-borrower Name:
  
Borrower Birthdate:
 Co-borrower Birthdate:
  
Street Address:
City:
 State:        Zip:
    		 
Do you own or rent this property?
How long have you been at the above address?

If less than 2 years at above address, please input your previous address and how long you lived there:
Home Phone:
Work Phone:
Cell:
e-mail:

 Information on current home

Current Market Value:
1st Mortgage Bal:
 Payment:
 Rate:
 Mortgage Holder:
 Years Left :
2nd Mortgage Bal:
 Payment:
 Rate:
 Mortgage Holder:
 Years Left :
Escrow Amount:
 If property is a mobile home
Do you own the land? If no, list lender: Width:
 Employment Information
Borrower
Co-borrower
SSN (optional):
Employer:
Job Title:
Dates of Employment:
 (mm/dd/yy)
to present
Gross monthly income:
Other income:
SSN (optional):
Employer:
Job Title:
Dates of Employment:
 (mm/dd/yy)
to present
Gross monthly income:
Other income:
If less than 2 yrs in current position, please list the following info from your previous employer:
Borrowers previous employers
Co-Borrowers previous employers
Bankruptcy:
Year: Discharged:
Bankruptcy:
Year: Discharged:
 For the analysis, do you need any of the following?
A shorter loan term? 10   15 20   25   30 years  
Cash out amount Debt consolidation amount:
Contact me
Best time I can be reached:

I authorize United Capital Mortgage to do an in-file credit report for pre-qualification Yes No

Who were you referred by?