Pre-Qualify

CREDIT APPLICATION

Borrower Information:		Co-borrower information
First Name:*		First Name:
Last Name: *		Last Name:
Social Security:*		Social Security:
Date Of Birth:*		Date Of Birth:
E-Mail Address:		E-Mail Address:
Home Phone:*		Home Phone:
Cell Phone:		Cell Phone:
Employment History: 2yrs		Employment History: 2yrs
Current Employer:		Current Employer:
Work Number:		Work Number:
Address:		Address:
City:		City:
State:		State:
Zip:		Zip:
Employment Dates:		Employment Dates:
Do you recieve:	1099 W2	Do you recieve:	1099 W2
Job Title:		Job Title:
Other Income (specify)		Other Income (specify)









Current Address:*		Current Address:
City:*		City:
State: *		State:
Zip:		Zip:
Rent Amount:		Rent Amount:
Dates Lived:		Dates Lived:






Banking Information:		Banking Information:
Reserves:		Reserves:
Checking/Savings:		Checking/Savings:
Retirement/401K:		Retirement/401K:
Gross Monthly Income:*		Gross Monthly Income:
Other:		Other:
Child Support:	No Paying Receiving	Child Support:	No Paying Receiving
Amount $:		Amount $:
What area are you intrested in?
County:
School District:
State:		I/we, as applicant(s) certify that all information provided above is true, accurate and complete to the best of my/our knowledge and is being provided for the purpose of obtaining credit. I/we, as applicant(s), authorize LongTide Homes, Ltd. To request a credit report and furnish a copy of this report and all other credit information to any and all lenders that LongTide Homes, Ltd. Deems appropriate and to release any of my/our credit-related or income-related information to such lenders.


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