The Plainsmen Financial Group, Inc.


Pre-Qualification Form
Please fill in the information below and click on the submit button. A Plainsmen representative will contact you within 24 hours.

Borrower

First Name:

Initial: Last:

SS#

Address:	( No P.O. Boxes Please)
City:	State: Zip Code:
Rent:	- Own: - # of Years:
Home Phone:	Work Phone: Ext:
Cell Phone:	Email:
Date of Birth:	Years of School:

Marital Status:	Married - Separated - Unmarried -
# of Dependants:	Ages:

Employer:	Years on job: Phone:
Self Employed?	Yes - No -
Previous Employer: (if less than 2 yrs.)	Phone:
Address:
City:	State: Zip Code:

Gross monthly income $	Other Income$ Source:



Co-Borrower
First Name:	Initial: Last:	SS#

Address:	( No P.O. Boxes Please)
City:	State: Zip Code:
Home Phone:	Work Phone: Ext:
Cell Phone:	Email:
Date of Birth:	Years of School:

Marital Status:	Married - Separated - Unmarried -
# of Dependants:	Ages:

Employer:	Years on job: Phone:
Self Employed?	Yes - No -
Previous Employer: (if less than 2 yrs.)	Phone:
Address:
City:	State: Zip Code:

Gross monthly income $	Other Income$ Source:

Subject Property Address (If different from above)

Address:
City:	State: Zip Code:

Purpose of Loan: Purchase - Construction - Refinance - Check if First Time Buyer:

Current Mortgages: First $ - Second $

If Refinance for CASH, how much cash requested? $ Purpose:

Sales Price or Estimated Value $

Property Type: Single Family - Condo - Duplex - Check if Non-Owner Occupied -

Assets

Name of Bank, Credit Union, or S&L with account# and average balance:

Retirement/Savings account name/number/amount:

Source of funds for closing will be coming from (i.e. Savings, Sale of home, gift, etc.):

Automobile(s) owned (year and make):

Do you pay Alimony or Child support? Yes - No - If Yes, how much monthly?

Click below to view our current rates or to use one of the associated calculators.
Current rates Payment calculator Renting Versus Owning

How did you hear about The Plainsmen Financial Group?

Additional Comments

By submitting this form you hereby authorize The Plainsmen Financial Group, Inc. to obtain your credit report and or

additional information to determine credit worthiness. This information is strictly confidential.