Prequalify - Keystone Builders

Borrower		Co-Borrower
First Name:		First Name:
Last Name:		Last Name:
Address:		Address:
City:		City:
State:		State:
Zip:		Zip:
Phone:	() -	Phone:	() -
Email:		Email:
Social Security #:	- -	Social Security #:	- -
Birth Date:		Birth Date:
Base Gross Monthly Income:		Base Gross Monthly Income:
Other Income:		Other Income:
Appx Checking Balance:		Appx Checking Balance:
Appx Savings Balance:		Appx Savings Balance:
Do you currently own a home?:
I hereby authorize third party mortgage lenders to make inquiries necessary to verify the accuracy of the statements made and to determine my creditworthiness. I certify that all the information is true and accurate as of today. These Statements are made for the purpose of qualifying for a mortgage loan.