Action Home Mortgage

Quick Qualifier Form

Simply supply us the following information. We'll determine the loan amount for which you may qualify, and the loan program that's right for you. This is not a mortgage application. All information is kept strictly confidential.

General Information

* Denotes Required Fields

Borrower's Name:*

Social Security No:*

Numbers only, no dashes please.

Co-Borrower's Name:

Social Security No:

Numbers only, no dashes please.

Address:*

Street Address, City, State, Zip

Home Phone:*

Numbers only, no dashes please.

Work Phone:

Numbers only, no dashes please.

Co-Borrower's Wk Phone:

Numbers only, no dashes please.

Income Information

Self-Employed?*

Borrower Base Pay:*

$

Co-Borrower Base:

$

Overtime: (2 yr history)

$

Bonuses: (2 yr history)

$

Commission: (2 yr history)

$

Alimony/Child Support:

$

(min. 3 yr continuance)

Other Income:

$

Debt Information

Credit Cards:

Monthly Payment:

$

Approx. Balance:

$

Car Loans:

Monthly Payment:

$

Approx. Balance:

$

Current Mortgage:

Monthly Payment:

$

Approx. Balance:

$

Installment Loans:

Monthly Payment:

$

Approx. Balance:

$

Student Loans:

Monthly Payment:

$

Approx. Balance:

$

Alimony/Child Support:

Monthly Payment:

$

Approx. Balance:

$

Other:

$

Asset Information

Approx. Check/Savings Account(s) Balance:

$

Other source of funds for closing:

$

* I authorize Action Home Mortgage, Inc. to conduct a credit check for the purposes of determining my loan eligibility

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