Short Loan Application

Short Loan Application

Welcome to MSA Mortgage, LLC's secure online pre-qualification form. Once you submit your information, it will receive immediate attention by one of our representatives.
Name*

First NameMiddle NameLast NameSuffix
Social Security Number*
Please enter 9 digits social security number
Date of Birth*

MonthDayYear
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Office Phone

Area CodePhone Number
Home Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
Preferred Number
Total Gross Yearly Income (Income Before Taxes) *
*Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements. Notice: Alimony, child support, or separate maintenance income need not be revealed if the Borrower(B) or Co- Borrower(C) does not choose to have it considered for repaying this loan.
Total Monthly Debt Payments (including Alimony & Child Support)
Current Employer
Number of Years
Co-Borrower Information
Will there be a co-borrower on this loan?

No co-borrowerSpouseOther
Name

PrefixFirst NameMiddle NameLast NameSuffix
Date of Birth

MonthDayYear
Date
Social Security Number
Please enter 9 digits social security number
Current Employer
Number of Years
Referral Information
Referred by
Loan Originator
Loan Information
Purpose of Loan
Property Type
Purchase Price
Amt Avail for Down Payment or Closing Costs
Credit Check Authorization
Do you authorize us to pull you and your co-borrower’s credit reports in order to pre-qualify you for a loan? (If so, please provide social security numbers and date of births).

YesNo
Should be Empty:

Short Loan Application

Co-Borrower Information

Referral Information

Loan Information

Credit Check Authorization