Mortgage Qualification Form

 

PLEASE BE AWARE THAT PROVIDING THIS INFORMATION IN NO WAY OBLIGATES YOU TO PURCHASE A HOME FROM ME.
PRIVACY ACT INFORMATION-The information collected on this form will serve as an application for credit from VA in connection with an offer to purchase a VA-acquired property. Failure to provide the requested information could result in failure to provide you with credit information. Under the Debt Collection Act of 1982, VA is required to collect the social security numbers of loan applicants. VA may conduct computer matches to verify the information which you furnish. Under the Financial Privacy Act of 1978, VA may obtain financial records held by financial institutions in connection with the consideration or administration of assistance to you. Such financial records will be available to VA without further notice or authorization. VA records will not be disclosed outside VA unless authorized by law including the routine uses identified in VA system of records, 55VA26, Loan Guarantee Home, Condominium and Manufactured Home Loan Applicant Records, Specially Adapted Housing Applicant Records and Vendee Loan Applicant Records-VA, published in the Federal Register.

RESPONDENT BURDEN: Public reporting burden for this collection of information is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

 

General Information
Applicant First Name:
Applicant Last Name:
Full Mailing Address:
City: State: Zip Code:
E-Mail Address:
Note: Please provide us with your E-mail address. This will make it easier for us to contact you during this process.
Number of years at this address:
 Requested loan amount:
$		 Down payment amount:
$
Applicant's daytime phone number:
 Marital Status: Unmarried
 Married Separated		 Ages of dependents other than spouse:
Name, mailing address and telephone number of relative not residing with applicant:
Applicant Spouse/Co-applicant
Date of birth:
 Social security number:
 Date of birth:
 Social security number:
Employer name and mailing address:

Self employed: Yes No

Years with employer:

Monthly income:

Job title/type of business:

Business phone number:

Employer name and mailing address:

Self employed: Yes No

Years with employer:

Monthly income:

Job title/type of business:

Business phone number:

Combined Assets and Cash/Market Values
Other loan/gift to buy this property $ Furniture, household goods $
Cash on hand, checking accounts $ Vehicle(s) $
Savings accounts, certificates, bonds $ Other $
Stocks, other securities $ Other $
Real estate owned other than home $ Other $
Check, Savings, and Investment Account Information
Please list all bank, credit union or other depository names, mailing addresses and the account balance for each:
Sources of income and combined expenses
Source of income and gross monthly amounts Applicant Borrower Spouse Co-applicant Combined expenses and gross monthly amounts Present Home Requested loan
Base salary, wages $ $ Home loan payment, rent $ $
Overtime, part-time $ $ Hazard/loan insurance $ $
Bonuses, commissions $ $ Real estate taxes $ $
Interest, dividends $ $ Home owner association dues $ $
Pension, compensation $ $ Dependant care $ $
Real estate rental $ $ Other $ $
Disclose the following income only if needed to repay the loan. Please be prepared to send copies of court documents and evidence of payments.  
Alimony, separate maintenance $ $  
Child support $ $  
Loans and other credit information

(List your charge card accounts, installment loans, and other debts you owe. Include present landlords with other creditors. Please e-mail us , if necessary, to list and explain additional credit accounts, including any past due amounts, judgments, collections and foreclosures against you, deed in lieu of foreclosure, bankruptcies filed within the past seven years and court orders to pay separate maintenance, alimony or child support.)
Please list all creditors, mailing addresses, current balance, and monthly payments: