* I/we are interested in becoming pre-qualified to: Purchase a new home Refinance our existing mortgage Obtain a second mortgage/home equity loan

* Were you referred to us? Yes No If Yes, who referred you?

Please identify and describe yourself: * Your Name Spouse's Name * Address * City * State * Zip * Telephone * Email

* Income * Primary Applicant Spouse Wages, Salary, etc. $ $ Overtime, Bonuses $ $ Investment Income $ $ Other Income $ $

Current Non-Housing Debt * Primary Applicant * Monthly Payment * Balance Owed $ $ $ $ $ $

Housing Expenses Existing FIRST mortgage Will this loan be paid off through refinance of your home at this time? Yes No Existing SECOND mortgage Will this loan be paid off through refinance of your home at this time? Yes No Existing Homeowner's Association Dues $ per year We rent our house for $ per month

Cash and Equity Reserves   Name of Institution Current Balance * Checking /Saving * Money Market * Stocks /Bonds Realistic estimate of your home's market value:

Credit History The final step in determining qualifications is a review of credit worthiness. If you would like Integrity Home Mortgage Corporation to obtain your credit history report, please complete the following.   * Primary Applicant Spouse * Social Security Number     * Date of Birth