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Borrower

Phone

If Less than 2 years

Employment:

If Less than 2 Years

Co-Borrower

Phone

If Less than 2 Years

Employment

If Less than 2 Years

Other Properties

Credit Information

Assets

This is to certify that I have provided the information given above for preliminary mortgage qualifying purposes and that it is true and correct to my knowledge.  By signing this application, I certify and authorize Main St Mortgage Inc to obtain credit-reporting information in order to make a preliminary credit decision. This application in no way implies credit approval nor the a promise from Main St. Mortgage Inc to provide a loan.  The approval is pending verification of all financial information, income information and completion of the actual mortgage application process. I also give Main St Mortgage Inc. permission to contact me electronically via e-mail or text.