Pre-Qual Purchase Inquiry Form

First Name *

Last Name *

Phone *

Email *

Current Address

Street Address

City

State

Country

Postal code

Rent or Own *

Rent

Own

How Long? *

How many years?

Additional Credit Obligations

Auto Payment?

Lease

Purchase

Auto Loan Balance

Credit Cards?

yes

Minimum Credit Card Payment

Credit Card Balance

Student Loans

yes

Student Loan Minimum Payment

Student Loan Balance

Property and Loan Information

Est. Purchase Price *

Est. Loan Amount *

Est. Down Payment *

Employment and Income Information

What is your current employment status?

Employed

Self-Employed/1099 Independent Contractor

Retired

Other...

Employer Name (if applicable)

how many years at current job?

Gross Monthly Income

Additional Income

Credit and Financial Information

Do you have any outstanding Judgements, liens or Bankruptcies?

Yes

If yes please explain:

Additional Information

Any additional questions or comments?

Authorization and Agreement

I authorize Secured Lending Group to review my financial

information for the purpose of assessing my refinance eligibility.

Date

Signature *

Clear