Pre-qualify To Purchase Your Home
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MORTGAGE
General Information
    What is the property
    type? *
Single Family
Condominium
Town House
Multi Family
    In which city property is
    located? *
    In which state property is
    located? *
Excellent
Good
    What is your credit
    history? *
Fair
Poor
Fico score, if available
    How did you hear about
    us?
Property Details
Primary residence
Investment
    How will you be using this
    property? *
Secondary residence
    What is property
    purchase price? *
$
 .00
    What is appraisal value
    of property? *
$
 .00
Loan Details
    What is your estimated
    loan amount? *
$
 .00
    What is your estimated
    down payment? *
$
 .00
Best Option
 Variable/Arm
    Which loan program do
    you prefer? *
Interest Only
Fixed
Under 30 days
    When would you needing
    this loan? *
 30 - 60 days
60 - 90 days
Undecided
Borrower Information
    What is your source of
    income? *
Self-employed
 Commission
Salary
Retirement
Income
Hourly wage/ Part-time wages
Other
(Alimony, public assistance, child support, etc.)
    What is your gross
    monthly income? *
$
 .00
    What is your  monthly
    housing debt? (eg. Rent) *
$
 .00
    Do you have other
    monthly debt? (eg. Auto
    loans, credit card) *
If none, type 0
$
 .00
Employed
Self Employed
    What is your employment
    status? *
Retired
Not Employed
    Have you ever filed
    bankruptcy? *
 No
 Yes
If yes, which year?
Collection amount
and date paid:
$
Judgement amount
and date paid:
$
    Are you currently working
    with a Realtor? *
Yes
 No
Contact Information
    First Name *
    Last Name *
    Email Address *
    Address *
    City *
 State *
    Zip Code *
    Phone Number *
    Alternate Phone
    Number
    Comments
Yes, I agree to terms and condition given below.
This form is not an application for a loan, nor a commitment to make a loan. The dollar
amount considered for loan is only based on information provided by you. By
submitting this information request form, your information will be sent to our
participating lenders. We will contact you regarding your request. Your privacy is our
priority and we will not provide your information to third party.
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Privacy Policy
Your privacy is important to
us. We are committed to
protecting your personal
information and use them
only as appropriate to
provide you with the best
possible service.
Note: MCIS Multichoice Insurance Services is not a mortgage broker neither affiliated with any mortgage company. This service is not provided by MCIS Multichoice
Insurance Services. There are individual agents who provide  these services and they are affiliated with other mortgage brokerage company.
* denotes required information
(510) 676 - 2247