1.Name:

2.Social Security #:

3.Name

4. Social Security#

5.Address:

6.City:

7.State/Zip:

8.Phone: (H) (W) (H)

9.Employer Name:

10.Length of Employment:

11. Job Title/Pay Grade: ETS Date:

12.Wages (monthly): $

Monthly Expenses: (Minimum payment on credit cards)

13.Car: $ /Mo.

14.Loan: $ /Mo

15.Loan: $ /Mo.

16.Other:

17.Monthly Child Support:

18. Monthly Child Care

19.# of Children In Household

20.Arrival Date:

We hereby authorize a local mortgage company or bank to use credit reporting information for the purpose of this

21.pre-qualification:type in yes or no

22.Signature:

23.Date:

Mail or fax your Mortgage Loan Qualifier TO:Agent: Kenne-Jean Woods at Prudential Professionals Realty,101 Ringgold Rd. Clarksville, Tenn. 37042

TO SUBMIT BY E-MAIL

IF YOU ARE UNCOMFORTABLE IN E-MAILING YOUR SOCIAL SECURITY NUMBERS, JUST FAX OR CALL ME WITH YOUR NUMBERS & LEAVE THEM OFF THE FORM WHEN YOU E-MAIL.

(931)920-6811 FAX (931) 647 9999