Pre-Qualification and Application

Borrower's Information:

Name:

E-Mail Address:

Birth Day:

Social Security Number:

Home Telephone:

Current Address

Employer:

Work Telephone:

Years at Current Employer:

Position:

Years at Current Position:

Gross Income:

Income Type:

Social Security or Pension:Yes No If Yes, How Much:

Rec. 1099 or W-2's: Yes No If Yes, How Much:

Other Income:

Co-Borrower's Information:

Name:

Birth Day:

Social Security Number:

Home Telephone:

Current Address

Employer:

Work Telephone:

Years at Current Employer:

Position:

Years at Current Position:

Gross Income:

Income Type:

Social Security or Pension:Yes No If Yes, How Much:

Rec. 1099 or W-2's: Yes No If Yes, How Much:

Other Income:

Currently Renting Property:

RentYesNo Number of Years: Rental Amount:

Name of Landlord Or Apartment:

Current Home Owner:

Year Home was AcquiredPurchase Price:

Escrows:YesNo

Current Mortgage Company:

Current Interest Rate:Percent

Number of Years for Current Mortgage:

How did you hear about us?

The disclosure required by Section 80.9 of the regulations to be given at the time of application must be given at that time in Internet transactions as well as in face-to-face transactions. The form to be used for such disclosures does have a space for the applicant(s) to sign it, but a signature is not required. Absent a signature to prove that the disclosure was timely given, an Internet-based brokerage entity should adopt other procedures to be able to document that it gave the required disclosures on a timely basis. For example, electronic signatures could be utilized, or the broker or loan officer could require a return e-mail to confirm that the disclosure was given and received. A "system" report from the sender of the disclosure indicating that it had been electronically delivered would not suffice because of the inability of the electronic medium to ensure that the recipient was able to open attachments or otherwise ensure that the disclosure was actually seen by the recipient.
By Submitting this form I hereby authorize "The Mortgagee" and/or the private mortgage insurer and/or any investor whom "The Mortgagee" sells my loan, to verify my past and present employment earnings records, bank accounts, stock holdings, and any other balances contained in the loan application submitted. I further authorize the ordering of consumer credit report and verification of other credit information, including past and present mortgage and landlord references. The information obtained is to be used in the processing of my loan, and/or for quality control purposes. Notice to borrowers: This is notice to you as required by the Right to Financial Privacy Act of 1978 that HUMDA has the right to access to financial records held by financial institution in connection with the consideration of administration of assistance to you. Financial records involving your transaction will be available to either of these agencies or any institutional investor to which this loan may be offered for purchase without further notice or authorization, but will not be disclosed or released to another Government agency or department without your consent except as required by law.
WAC


Stacey Dawn Realty and Mortgage, LP

14607 FM 1488 Rd.

Magnolia, Texas 77354
Telephone: 832-250-7481

Faxcimile: 832-426-5779

TREC # 528724