CMFC - Prequalification Form

Helping Turn Dreams Into Realities on the Outer Banks of North Carolina

Pre-Qualification Form
Please be as complete as possible to assure a speedy and accurate report.

Borrower

First name
Last name
Middle initial
Title
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
Home Phone
FAX
E-mail

Employer
Position:
Annual Gross Income
Years Employed

Monthly expenses. (any long-term debt with more than 10 months left to pay.
Include car payments, alimony, etc.) Please don't list utility and insurance expenses.

	Monthly	Balance
Auto
Installments
Credit Cards

Additional Income / Expenses

CoBorrower

First name
Last name
Middle initial
Title
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
Home Phone
E-mail

Employer
Position
Annual Gross Income
Years Employed

Monthly expenses. (any long-term debt with more than 10 months left to pay.
Include car payments, alimony, etc.) Please don't list utility and insurance expenses.

	Monthly	Balance
Auto
Installments
Credit Cards

Additional Income / Expenses

Purpose of this transaction

Purchase	Primary Residence
Refinance - Rate & Term	Second (or Vacation) Home
Refinance - Cash Out - Amount	Investment

Additional Comments

A Coastal Mortgage Representative will contact you to review your qualification. If you are self-employed, our representative will discuss additional information required from self-employed borrowers.

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Coastal Mortgage Financial Corporation
(252) 441-2600 Fax (252) 441-4410
1-800-441-8480
2001 N. Croatan Highway
Kill Devil Hills, North Carolina 27948
e-mail: money@coastalmortgage.com

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Helping Turn Dreams Into Realities on the Outer Banks of North Carolina

Copyright 2006 CMFC. Last revised: April 02, 2008

Copyright 2006 CMFC.
Last revised: April 02, 2008