Borrower Information

Are you looking to: Purchase A Home Refinance An Existing Home

Referred by:

Borrower Name: *required

Date of Birth (please enter as mm/dd/yyyy):

Social Security Number: *required

Marital Status: Single Married

If applying for a Home Purchase Loan, please provide your mailing address. If applying for a Refinance, please provide the physical address of the mortgage to be refinanced:

Apartment Number:

City:

State: Select State 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 Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip:

Time at Current Address: 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 40+ years 0 1 2 3 4 5 6 7 8 9 10 11 months

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Please enter information for previous address:

Mailing Address:

Apartment Number:

City:

State: Select State 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 Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip:

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Home Phone: *required

Email:

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Employment/Income Information

Name of Employer:

Job Title:

Years on Job: 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 40+ years 0 1 2 3 4 5 6 7 8 9 10 11 months

Gross Income: $

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If less than 2 years at current job, please provide previous employment information:

Previous Employer's Name:

Job Title:

Years on Job: 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 40+ years 0 1 2 3 4 5 6 7 8 9 10 11 months

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Monthly Expenses (Excluding Utilities): $

Have you had a bankruptcy?: Yes No

If yes, please provide discharge date:

Month January February March April May June July August September October November December Day 01 02 03 04 05 06 07 08 09 10 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Year of discharge:

Child Support?: Yes No

If yes, amount of child support paid per month: $

Additional Financial Information

amount in Checking: $

amount in Savings: $

amount in Retirement: $

amount in Investments: $

Additional Properties Owned:

Please list any real estate you own as well as your monthly payments on that property (be sure to include second mortgage payment if applicable):

If you have a co-borrower,click here to add co-borrower information.

Co-Borrower Information

Co-Borrower Name:

Date of Birth (please enter as mm/dd/yyyy):

Social Security Number:

Marital Status: Single Married

Mailing Address:

Apartment Number:

City:

State: Select State 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 Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip:

Time at current address: 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 40+ years 0 1 2 3 4 5 6 7 8 9 10 11 months

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Please enter information for previous address

Mailing Address:

Apartment Number:

City:

State: Select State Select State 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 Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip:

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Home Phone:

Email:

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Employment/Income Information

Name of Employer:

Job Title:

Years on Job: 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 40+ years 0 1 2 3 4 5 6 7 8 9 10 11 months

Gross Income: $

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Previous Employer's Name:

Job Title:

Years on Job: 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 40+ years 0 1 2 3 4 5 6 7 8 9 10 11 months

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Monthly Expenses (Excluding Utilities): $

Authorize Kemp Ward to run your credit?: Yes No

Have you had a bankruptcy?: Yes No

If yes, please provide discharge date: Month January February March April May June July August September October November December Day 01 02 03 04 05 06 07 08 09 10 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Year:

Child Support?: Yes No

If yes, amount of child support paid per month: $

Additional Financial Information

amount in Checking: $

amount in Savings: $

amount in Retirement: $

amount in Investments: $

Property Information

When are you looking to make your purchase: Less than 6 months? More than 6 months?

Are you still looking for a home to purchase?: Yes, I am still looking. No, I have found a home.

Amount you plan to use for down payment: $

Desired loan amount: $

If you have a realtor, please provide their information:

Realtor Name:

Realtor Phone:

Realtor E-Mail:

If you don't have a realtor, would you like us to refer one to you at no additional charge?: Yes No

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You must agree to the following terms in order for us to process your Pre-Qualification Sheet:

I (We) hereby authorize Meridias Capital, their successors and/or assignees to obtain a credit report on me (us) from a consumer reporting agency and to obtain directly or indirectly, any applicable information necessary for the processing of my (our) real estate loan application including but not limited to verification of employment, earnings, bank records, and all mortgage accounts.

I (We) hold harmless Meridias Capital and their successors and/or assignees, or any companies or persons supplying this authorization as needed.

I have read and agree to the above terms *required