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Pre Qualify Form

BORROWER INFORMATION

Borrower's Name (include Jr. or Sr. if applicable)

Social Security: --

Home Phone:

Age:

Unmarried (Include single, divorced, widowed)    Married  Separated

Present Address:

City:
State: Zip:

Own   Rent   Years :

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If Resident at present address fro less than two years, complete the following:

Former Address:

City:
State: Zip:

Own   Rent   Years :

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If Resident at present address fro less than two years, complete the following:

Former Address:

City:
State: Zip:

Own   Rent   Years :

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EMPLOYMENT INFORMATION

Name and Address of Employer:

Self Employed	Yrs. on this job:
Yrs. employed in this line of work/profession:

Position/Title/Type of Business:

Business Phone Number:

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If employed in current position for less than two years or if currently employed in more than one position, complete the following:

Name and Address of Employer:

Self Employed	Yrs. on this job:
Yrs. employed in this line of work/profession:

Position/Title/Type of Business:

Business Phone Number:

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If employed in current position for less than two years or if currently employed in more than one position, complete the following:

Name and Address of Employer:

Self Employed	Yrs. on this job:
Yrs. employed in this line of work/profession:

Position/Title/Type of Business:

Business Phone Number:

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MONTHLY INCOME INFORMATION

Gross Monthly Income*
Base Empl. Income
Overtime
Bonuses
Commissions
Dividends / Interests
Net Rental Income
Other
Total

* Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.

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By typing my name bellow I authorize Ideal Properties to check my credit report using the information I provided in this form:

Type Name :         (Required)