MORTGAGE PREQUALIFICATION WORKSHEET

MORTGAGE PREQUALIFICATION WORKSHEET
4320 Linglestown Road, Harrisburg PA 17112
717.657.7727 | CentricBank.com
1 | BORROWER’S PERSONAL INFORMATION
Last Name
First Name
Middle Initial
City
State
Zip
Home Phone
Cell Phone
Work Phone
Email
Social Security No.
Birthdate (MM/DD/YYYY)
Home Address
2 | BORROWER’S EMPLOYMENT INFORMATION
Employer
Full Time:
Position
Hourly
Years Employed
Gross Monthly Income
Yes
No
Salary
Commission
Other Income*
* Do not reveal income from alimony, child support, or separate maintance payments unless you are relying on such income to repay this account.
3 | CO-BORROWER’S PERSONAL INFORMATION
Last Name
First Name
Middle Initial
City
State
Zip
Home Phone
Cell Phone
Work Phone
Email
Social Security No.
Birthdate (MM/DD/YYYY)
Home Address
4 | CO-BORROWER’S EMPLOYMENT INFORMATION
Employer
Full Time:
Position
Hourly
Years Employed
Gross Monthly Income
Yes
No
Salary
Commission
Other Income*
* Do not reveal income from alimony, child support, or separate maintance payments unless you are relying on such income to repay this account.
5 | CREDIT AUTHORIZATION
By signing below, I authorize Centric Bank to obtain my credit report. I also authorize Centric Bank to provide my credit report to any affiliate of Centric Bank for their
review. I understand that if I have any questions, disputes, or comments about the information on my credit report, I must contact the credit reporting agency to address
these issues. This authorization is not an application for credit, nor is it a request to Centric Bank to consider an application from me for credit.
Borrower’s Signature
Date
Co-Borrower’s Signature
Save the completed worksheet to your computer and submit to:
• Postal Mail - P.O. Box 62090, Harrisburg PA 17106-2090; Attn: Getty Wilson
Thank you! We will contact you within 48 hours of receiving your completed worksheet.
GETTY WILSON, NMLS 586367
Vice President, Mortgage Department Manager
P: 717 909 8302 | E: [email protected]
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