The Plainsmen Financial Group, Inc.


Pre-Qualification Form
Associate: Marty Muck
Please fill in the information below and click on the submit button.

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:



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: (If different from above)

Address:
City:	State: Zip Code:

Purpose of Loan: Purchase - Construction - Refinance -

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 Rate Table Current rates Monthly Payment Calculator Payment calculator Rent vs Owning Calculator Renting Versus Owning

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.