Borrower (Last Name):     (First Name):
SS#:     Date of Birth (mm/dd/yy):
Street Address:
City:     State:     Zip:
Phone/Cell:     Email:
Driver License/ID: No: State   
Gross Salary (per month):
Current Employment: yr  month

Co-Borrower (Last Name):     (First Name):
SS#:     Date of Birth (mm/dd/yy):
Street Address:
City:     State:     Zip:
Phone/Cell:     Email:
Driver License/ID: No: State   
Gross Salary (per month):
Current Employment: yr  month

Liabilities:
Have you had foreclosure in the last 7 years? No Yes
Bankruptcy in the last 7 years? No Yes   Discharge date:
Do you have any outstanding judgments? No Yes   If yes, list:
Do you have any outstanding collections? No Yes   If yes, list:

Authorization to Release Credit Information (please check both boxes below):
Yes No I authorize Five Star Mortgage, Inc. and/or assigns to obtain my/our credit report and/or any additional information to determine credit worthiness.
Yes No The information that is obtained is strictly confidential; this online form or a photocopy or facsimile of this authorization may be deemed to be the equivalent of the original.

This pre-qualification is not a loan application.  Your loan application will begin upon receipt of a signed Uniform Resident Loan Application.