Mortgage Application

First Security Mortgage Corp.

Pre-Qualification Form

Personal Data
How did you hear about us?
What type of financing are you interested in?
Name * First Last
Email *
Social Security Number *

Please enter your SSN in the following format 000-00-0000
Birthdate * / MM / DD YYYY
Spouse's Name First Last
Spouse's Social Security Number

Please enter your SSN in the following format 000-00-0000
Spouse's Birthdate / MM / DD YYYY
Current Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone * - (###) - ### ####
I currently: * Rent Own
Employer *
Position/Rank *
How long with company? *
Gross Monthly Income *
Spouse's Employer
Spouse's Position/Rank
Spouse - How long with company?
Spouse - Gross Monthly Income
Property 1
Property 1 Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Property 1 Monthly Payment
Property 1 Monthly Rent
Property 1 to be sold? Yes No Third option
Property 2
Property 2 Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Property 2 Monthly Payment
Property 2 Monthly Rent
Property 2 to be sold? Yes No
Additional Comments
AGREEMENT:
I/we certify that the above information is true and accurate to the best of my/our knowledge.
I/we have given this information to First Security Mortgage Corp. for the purpose of obtaining credit which will be secured by a first mortgage on a property acceptable to First Security Mortgage Corp. and I/we acknowledge that First Security Mortgage Corp. will rely on this information in considering my application for the loan approval certification.
I/we give permission for First Security Mortgage Corp to obtain a credit report. * I/we have read and agree to the above.
Name of Borrower * First Last
Date * / MM / DD YYYY
Name of Co-Borrower
Date / MM / DD YYYY

First Security Mortgage Corp.

First Security Mortgage Corp.

Personal Data

Property 1

Property 2

AGREEMENT: I/we certify that the above information is true and accurate to the best of my/our knowledge.

AGREEMENT:
I/we certify that the above information is true and accurate to the best of my/our knowledge.