Home Application Offices Services

 

Kentucky Loans Only

Authorization to Release Information Form

   

TRI-COUNTY MORTGAGE CO., INC.
Pre-qualification Application


 



 

Loan Officer you wish to work with:
 

Date:               Loan Type:           Customer Goal:


Borrower Information

Name:

Address:

 

City:

State:

Zip Code:

Phone:

Email:

Social Security Number:

Date of Birth:

Marital Status:

Years of School Completed:

Rent   Own     Number of Years: 

   
   
   
 

Assets & Liabilities

Assets

Gross Monthly Income:
Checking & Savings Balance:
401K or Retirement:
Stocks & Bonds:
Real Estate Owned:
   
   
   
   
   

Liabilities

Rent:
First Mortgage:
Other Financing:
Hazard Insurance:
Real Estate Taxes:
Mortgage Insurance:
Other:
   

Liabilities (Continued)

1. Company Name:
Address:
 
City, State, Zip:
Monthly Payment:
Months Left to Pay:
Unpaid Balance:
   
2. Company Name:
Address:
 
City, State, Zip:
Monthly Payment:
Months Left to Pay:
Unpaid Balance:
   
   
   
   

Employment Information ( Two Year Employment History Required )

Company Name:

Address:
 
Phone:
Years on Job:
 

If employed in current position for less than two years or if
currently employed in more than one position, complete the following:

Company Name:
Address:
 
Phone:
Dates: From:      To:
   
 
Have you been declared bankrupt within the past 7 years?  
If Yes, When?  
Do you pay alimony, child support or separate maintenance?  
Are you a U.S. Citizen?  
     

Co-Borrower Information

Name:

Address:

 

City:

State:

Zip Code:

Phone:

Email:

Social Security Number:

Date of Birth:

Marital Status:

Years of School Completed:

Rent   Own     Number of Years: 

   
   
   
   

Employment Information ( Two Year Employment History Required )

Company Name:

Address:
 
Phone:
Years on Job:
Gross Monthly Income:
Other Monthly Income:
   

If employed in current position for less than two years or if
currently employed in more than one position, complete the following:

Company Name:
Address:
 
Phone:
Dates: From:      To:
   
 
Have you been declared bankrupt within the past 7 years?  
If Yes, When?  
Do you pay alimony, child support or separate maintenance?  
Are you a U.S. Citizen?  
 

Property Information

Property Address You Wish To Finance:
 
Estimated Property Value:
Down Payment:
 

Acknowledgment & Agreement

Each of the undersigned specifically represents to Lender's actual or potential agents, brokers, processors, attorneys, insurers, servicers, successors and assigns and agrees and acknowledges that (1) the information provided in this application is true and correct as of the date set forth opposite my electronic signature and that any intentional or negligent misrepresentation of this information contained in this application may result in civil liability, including monetary damages, to any person who may suffer any loss due to reliance upon any misrepresentation that I have made on this application, and/or in criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Sec 1001, et seq.; (2) the loan requested pursuant to this application (the "Loan") will be secured by a mortgage or deed of trust on the property described in this application; (3) the property will not be used for any illegal or prohibited purpose or use; (4) all statements made in this application are made for the purpose of obtaining a residential mortgage loan; (5) the property will be occupied as indicated in this application; (6) the Lender, its servicers, successors or assigns may retain the original and/or an electronic record of this application, whether or not the Loan is approved; (7) the Lender and its agents, brokers, insurers, servicers, successors, and assigns may continuously rely on the information contained in this application, and I am obligated to amend and/or supplement the information provided in this application if any of the material facts that I have represented herein should change prior to closing of the Loan; (8) in the event that my payments on the Loan become delinquent, the Lender, its servicers, successors or assigns may, in addition to any other rights and remedies that it may have relating to such delinquency, report my name and account information to one or more consumer reporting agencies; (9) ownership of the Loan and/or administration of the Loan account may be transferred with such notice as may be required by law; (10) neither Lender nor its agents, brokers, insurers, servicers, successors or assigns has made any representation or warranty, express or implied, to me regarding the property or the condition or value of the property; and (11) my transmission of this application as an "electronic record" containing my "electronic signature," as those terms are defined in applicable federal and/or state laws (excluding audio and video recordings), or my facsimile transmission of this application containing a facsimile of my signature, shall be as effective, enforceable and valid as if a paper version of this application were delivered containing my original written signature.

Acknowledgement. Each of the undersigned hereby acknowledges that any owner of the Loan, its services, successors and assigns, may verify or re-verify any information contained in this application or obtain any information or data relating to the Loan, for any legitimate business purpose through any source, including a source named in this application or a consumer reporting agency. I also acknowledge that I have read and agree with the Fair Credit Reporting Act & Authorization to Release Information Form.

 

Type your name in the box as your electronic signature and to agree with all of the above.

Borrower
Co-Borrower
 



Copyright 2004 by Tri County Mortgage, All Rights Reserved

No portion of this website may be copied without the written permission of Tri County Mortgage
 

Website Maintained by:   4ever Graphics & Design