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Full Name

State You Plan to Purchase

Combined Annual Income

Occupancy of Subject Property

Are you active Military or Veteran?

Yes No

Have You Owned a Home Before?

Yes – 3+ Years Yes – Purchased within 3 years No

Loan Purchase

Purchase ((see below)) Refinance Access Equity

Type of Loan Program Inquiring About

Property Type

Credit History

Any past hardships or derogatory events?

Time Frame

Est. Purchase Price Range

Source of Down Payment

Do you need to sell first?

Are you working with a Real Estate Agent yet?

No Yes

Phone

Best Time to Call

Preferred Method of Contact

Do you have any specific questions?

Completing this form may not result in a prequalification or pre-approval. A prequalification is not an actual loan approval. Each Loan Officer acknowledges and adheres to Fair Housing / Equal Opportunity.

Already prequalified? Contact us for a second opinion.

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Karina Saldarriaga
Originating Branch Manager
NMLS #312137
Licensed in: California

Have a Question? Let’s connect!

Every mortgage situation has a solution unique to you. Schedule a quick phone call or zoom. Leave your details and we’ll get back to you ASAP.

Chad Baker, CrossCountry Mortgage
NMLS# 329451 | CCM NMLS# 3029

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