Consumer Application - Complete Form

Prequalification Setup Form

What type of loan do you want?
(Home Equity Loans, Second Mortgages, Construction and Land Loans are not available.)
Purchase-Under Contract
Purchase-Contract Pending
Purchase-Preapproval Only
Refinance
Cash-Out Refinance

For what type of residence?
Primary Residence
Second Home
Investment Property
(Not owner-occupied)

For what type of property?
Single Family
2-4 Unit
Condominium
# of Floors (if Condo)
Condo Fee (if Condo)

Property Information:
(Loans are not available for properties outside of the USA.)

How should we contact you?
(Please provide an email address and at least one phone number.)

Sales Price (or Value if a Refinance)

Home:
Work:
E-Mail:
Fax:

Down Payment (5%, 10%, etc.)

Loan Amount (Approximate)

Street Address, if known

City

County

State (Required)

Estimated Closing Date

You	Co-Applicant		You	Co-Applicant
		First Name			Present Employer
		Middle Initial			Start Date
		Last Name			Title
		Other (Jr/Sr, MD, etc.)			Gross Monthly Income
		Birthday (MMDDYY)			Bonus, etc. (Monthly)
		Street Address
		City			Other Income Source
		State			How Long Receiving
		Zip			Monthly Amount
		Since (Mo/Yr)	Please Note: Alimony, child support, or separate maintenance income need not be revealed if you do not wish it to be considered as a basis for repaying this obligation.
Own Rent
		Landlord's Name
		Landlord's Phone Number
		Monthly Rental Payment

Regarding your and your co-applicant's assets: (Include checking, savings, investments, mutual fund, retirement accounts or gift funds if any.)			Regarding your and your co-applicant's loans: (Do not include mortgage loans-see below.)
Institution	Balance	Type of Acct	Type of Loan	Lender	Monthly Pymt	Balance Owed

Property 1	Property 2		Property 1	Property 2
		Property Address			Mortgage Lender
		Property City			Account Number
		Property State			Date Originated (Mo/Yr)
		Enter S if Sold, PS if Pending Sale or R if Rental			Mortgage Balance
		Purchase Price			Mortgage Payment
		Market Value			Rental Income

If you answer "yes" to any of these questions, please use the section below for explanation.	You	Co-Applicant
Are there any outstanding judgments against you?	Yes No	Yes No
Have you had a bankruptcy within the past 7 years?	Yes No	Yes No
Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?	Yes No	Yes No
Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment?	Yes No	Yes No
Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee?	Yes No	Yes No
Are you obligated to pay alimony, child support, or separate maintenance?	Yes No	Yes No
Is any part of the down payment borrowed?	Yes No	Yes No
Are you co-maker or endorser on a note?	Yes No	Yes No
Are you a US citizen?	Yes No	Yes No
Are you a permanent resident alien?	Yes No	Yes No
Do you intend to occupy the property as your primary residence?	Yes No	Yes No
Have you had ownership interest in a property in the last three (3) years?	Yes No	Yes No

Any comments or loan questions you may have:

Please click on "Submit this Application" below if you agree to the following:

I am submitting the information on this form in order that Pacific Mortgage Brokers (PMB) may evaluate my financial situation and estimate the amount of loan I might obtain.

I understand that this request for Prequalification is being made to BigEMortgage not to PMB Online. PMB Online is not a lender, and I agree I will not hold PMB Online liable for any matters pertaining to the loan I might obtain.

In choosing to submit the information on this form electronically, I acknowledge that, regardless of the fact that Netscape Navigator secure server features are available, PMB Online is unable to ensure that the data can not be intercepted by third parties. I agree that neither PMB Online will be held liable should such interception occur.