Prequalification and Credit Authorization

To determine the loan amount that you may qualify for based on your income and liabilities, please complete this form. You can be sure the information provided for the purposes of pre-qualification will be strictly confidential. With written authorization to evaluate your personal financials and pull your credit, we will be able to determine whether you qualify for a loan and identify the proper loan program for you. Privacy Act Notice: This information is to be used by the agency collecting it or its assignees in determining whether you qualify as a prospective mortgagor under its programs. It will not be disclosed outside the agency except as required and permitted by law. You do not have to provide this information, but if you do not your application for approval as a prospective mortgagor or borrower may be delayed or rejected. This information requested in this form is authorized by Title 38, USC, Chapter 37 (if VA); by 12 USC, Section 1701 et. seq. (if HUD/FHA); by 42 USC, Section 1452b (if HUD/CPD); and Title 42 USC, 1471 et. seq., or 7 USC, 1921 et. seq. (if USDA/FmHA).

Information is sent by secure encryption and delivered directly to the Pacific Home Brokers Inc. and your loan officer.


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Borrower Information

Only one Borrower per form. If there is a Co-borrower then another form needs to be filled out.


Loan Purpose:  



Loan Officer's Name:  

Real Estate Agent's Name:  

Social Security #:  

Date of Birth:  




Zip Code:  

Years At Address:  

Phone # Cell:  

Daytime #:  

Email Address:  

Current Rent or N/A:  

Current Mortgage or N/A:  



How Long Employed with this Employer:  

What is Your Employer's Phone Number:  

Gross Monthly Income:  

Other Income (part-time/pension/disability/retirement/dividends):  

Total Cash To Use For The Purchase, N/A for Refinance:  

What is the Discharge Date If You Filed Bankruptcy in the Last 7 Years or N/A:   

What was the Sale Date for Your Foreclosure in the last 7 years or N/A:  

What is The Total Minimum Payments for Alimony or N/A:  

What is The Total Minimum Payments for Child Support or N/A:  

What is The Total Minimum Payments for all Car Loans or N/A:

What is The Total Minimum Payments for all Student Loans or N/A:  

What is The Total Minimum Payments for all Credit Cards or N/A:  

What is The Total Minimum Payments for any Equity Line of Credit or N/A:  


I hereby authorize the Lender/Broker to verify my past and present employment earnings records, bank accounts, stock holdings, and any other asset balances that are needed to process my mortgage loan application. I further authorize the Lender/Broker to order a consumer credit report and verify credit information, including past and present mortgage and landlord references. it is understood that a copy of this form will also serve as authorization.

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Signature Certificate
Document name: Prequalification and Credit Authorization
lock iconUnique Document ID: 84e3862cb019f06cff7f4af83dcad65f31286aa5
Timestamp Audit
November 16, 2015 3:23 pm PDTPrequalification and Credit Authorization Uploaded by PHB Support - IP