Prequalify

Start Your Home Search The Smart Way..... Get Prequalified First

Your personal information will be held in strict confidence.  I will not sell, trade
or rent your information with any unauthorized authority.

Borrower Information:
 
Borrower (Full Name):
Date of Birth: (ex. dd/mm/yyyy)
Soc. Insurance #:
Residence Phone #:
Business Phone #:
Present Address:
City:
Province:
Postal Code:
E-mail Address
Years at Present Address:   Rent $ /month
or Own $
 
Previous Address:
City:
Province:
Postal Code:
Marital Status: Married
Separated
Unmarried (including single, divorced, or widowed)
  
Occupation:
   (Position & Title)
# of years:
Place of Employment:
  (Name & Address)
Previous Employer:
   (Name & Address)
Co-Borrower Information:
 
Co-Borrower (Full Name):
Date of Birth: (ex. dd/mm/yyyy)
Soc. Insurance #:
Residence Phone #:
Business Phone #:
Present Address:
City:
Province:
Postal Code:
E-mail Address
Years at Present Address:     Rent $  /month
or   Own $ 
 
Previous Address:
City:
Province:
Postal Code:
 
Marital Status: Married
Separated
Unmarried (including single, divorced, or widowed)
 
Occupation:
   (Position & Title)
# of years:
Place of Employment:
   (Name & Address)
Previous Employer:
   (Name & Address)
Gross Annual Income:
 
Borrower Co-Borrower
Self-Employed ? Yes    No Yes    No
Base Salary: $ $
Overtime: $ $
Bonuses: $ $
Commissions: $ $
Dividends: $ $
Net Rental Income: $ $
Other: $ $
 

Total: $ $
 
Do You Intend To Occupy This Property ?    Yes     No
Number of Children:
Ages:
Other Dependents:
 
Assets:
  Other Assets (Specify):
Checking: $  Bank:
$  Bank:
Savings: $  Bank:
$  Bank:
Credit Union: $  Bank:
Stocks: $
Bonds: $
Life Insurance: $
 
Present Residence  (If Owned):
Market Value: $
Morg. Value: $
Lender:
 
 
Liabilities:
 
(List outstanding obligations including auto loans, mortgage payments,credit cards,
personal loans, and all other loans.)
 
Type Creditor's Name Unpaid Balance Due Date Monthly Payment
$ $
$ $
$ $
Total:   $ $
 
Additional Monthly Obligations:
Alimony:  $
Child Support:  $
Child Care:  $
 
Are There Any Judgements or Lawsuits Present?   Yes    No
Amount:  $
Is Any Part of the Down Payment or Settlement Costs
Being Obtained From a Source Other Than From Assets
Listed Above?
  Yes    No
I hereby give my consent to have my credit report secured
from any credit reporting agency which you designate.
  Yes    No


Colin Gilroy
Royal LePage Dynamic Real Estate
1450 Corydon Ave, Winnipeg, MB R3N 0J3
Phone: (204)-989-5000
Cell: (204) 226-4909