Free Loan Qualifying

& Pre-Approval

Submit the info. below for confidential consulting

to determine the price range,  total cash outlay,

monthly payment, that will best define

your ideal home-loan. 

Borrower Co-Borrower

Name: Name:

Address: City: State: Zip:  

E-mail: Phone:

Are you self employed ? Yes No                                                                   Are you self employed ? Yes No

Gross Monthly Income: Gross Monthly Income:

Time on Current Job: Years   Months                                           Time on Current Job: Years   Months

Time in Same Line of Work: Time in Same Line of Work:

Social Security # (optional): Social Security # (optional):

                         Balance         Payment                                                                                       Balance         Payment

Car Payment:                                                           Car Payment:

Visa Card: Visa Card:

Master Card: Master Card:

*Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.
**Notice: Alimony, child support, or separate maintenance income need not be revealed if the Borrower(B) or Co-Borrower(C) does not choose to have it considered for repaying this loan.

By submitting this online mortgage application, I/we authorize Keith Rossignol or his assignees to check my/our credit status.

Other information and comments

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