Mortgage Pre-Qualification Form

Dear Homebuyer,

Congratulations on taking the next step towards getting pre-qualified for a new home purchase!

Please take 5-10 minutes to fill out the Loan Questionnaire below from my trusted lender, Scott Moon (NMLS #1492315), with NEXA Mortgage - the largest mortgage broker in the country with access to interest rates and loan programs from over 180 lenders. If you prefer to reach out to Scott directly, feel free to call, text or email him at (202) 352-5625 or smoon@nexamortgage.com. After Scott and I have reviewed your information, we will be in a better position to advise you on a new home purchase.

As a home buyer, you are of course welcome to use any lender that you choose.

Erica Cannon-West
Realtor
Samson Properties
erica@l2realtypartners.com
(203)360-8645

Mortgage Loan Questionnaire
First Name
Middle Name
Last Name
Residential Status
Visa Type
Marital Status
Do you have dependents?
Ages of dependents, separated by commas
4, 7, 9, etc
Email Address
Cell Number

Area CodePhone Number
Home Number

Area CodePhone Number
Current Address

Street Address

Apartment

CityState

Zip Code
Do you rent or own currently?
If you own, what will you be doing with your primary residence?
How long have you lived at this address? Estimated Years & Months
Years
Months
Current Monthly Rental Payment
Previous Address if at Current Property Less Than 2 Years

Street Address

Street Address Line 2

CityState

Zip Code
How long did you live at this address?
Current Employer
Position
Years in this line of work
Estimated Start Date with this employer

MonthDayYear
Employer Phone Number

Area CodePhone Number
Employer Address

Street Address

Street Address Line 2

CityState

Zip Code
How do you get paid?
Aditional Income
What is your base salary?
What is your hourly rate and guaranteed number of hours worked per week?
Rate / Hours
Are you Self Employed? (This includes 1099 employees)
Do you have a second job?
Are you obligated to pay court ordered alimony or child support?
How much are you obligated to pay monthly?
What's an idea of minimum monthly debt payments for you and your co-borrower?
(Car Loans, Student Loans, Personal Loans, Mortgage Payments, Minimum Credit Card Payments)
Birth Date

MonthDayYear
- First Name
- Middle Name
- Last Name
- Birth Date
  
  MonthDayYear
- Residential Status
- Visa Type
- Marital Status
- Do you have dependents?
- Ages of dependents, separated by commas
  4, 7, 9, etc...
- Email Address
- Cell Number
  
  Area CodePhone Number
- Home Number
  
  Area CodePhone Number
- Current Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- How long have you lived at this address? Estimated Years & Months
- Years
- Months
- Previous Address if at Current Property Less Than 2 Years
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Current Employer
- Position
- Years in this line of work
- Estimated Start Date with this employer
  
  MonthDayYear
- Employer Phone Number
  
  Area CodePhone Number
- Employer Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- How do you get paid?
- Additional Income
- What is your base salary?
- What is your hourly rate and guaranteed number of hours worked per week?
  Rate / Hours
- Are You Self Employed? (Includes 1099 employee)
- Are you obligated to pay court ordered alimony or child support?
- How much are you obligated to pay monthly?
- What is the maximum monthly mortgage payment that you are comfortable with? (This includes Property Taxes and Insurance) This will help us determine your maximum pre-approved price range.
- Realtor's Name
- Realtor's Phone Number
- Please feel free to list any addtional comments below:
- This mortgage loan questionnaire is designed to aid the Mortgage Loan Originator in initial consultation with consumers who are seeking guidance and information in preparation for applying for a mortgage loan in the future. This is not a loan application as defined by 24 CFR and 3500.2 (b) of The Real Estate Settlement and Procedures Act or by ECOA. Completion of this form will not result in any type of formal loan evaluation or underwriting.
  
  Privacy Notice: NEXA Mortgage, LLC does not disclose any non-public personal information about the clients for any purpose that is not specifically permitted by law. We restrict access to non-public personal information about you to those employees who need to know in order to provide services to you. We maintain physical, electronic, and procedural safeguards that comply with federal regulations to guard your non-public personal information. This mortgage loan questionnaire is not a mortgage loan application. If you entered your name(s) above, you are authorizing NEXA Mortgage, LLC to pull your credit report(s) for consultation purposes only. NEXA Mortgage, LLC is a licensed Mortgage Lender (NMLS #1660890 www.nmlsconsumeraccess.org).
- Enter the message as it's shown
- Should be Empty:

Mortgage Loan Questionnaire