Coldwell Banker Preferred

Pre-qualifying for a mortgage is the first step to home ownership. Just complete the information below and you are on your way to becoming a new homeowner. Compliments of Monica "Mortgage" Palatano Fax# 215 646 3285 or 484 531 5837 Phone# 610 637 1155

* = Required Fields

Borrower

First Name	*
Last Name:	*
Street Address	*
City	*
State	Zip Code *
Date of Birth	*
Monthly Rent/Mortgage Payment	*

Employer's Name	*
Employer's Street Address	*
City	*
State	Zip Code *
Position	*
Length of Employment	*
Gross Annual Income


Co-Borrower (if applicable)

First Name
Last Name
Street Address
City
State	Zip Code
Date of Birth
Monthly Rent/Mortgage Payment

Employer's Name
Employer's Street Address
City
State	Zip Code
Position
Length of Employment
Gross Annual Income

Sales Price Range Desired	-
Cash available to purchase:
Bank Account
Sale of Home

Work Phone	*
Cell Phone
Home Phone	*
Email Address:	*
Real Estate Agent	*

Additional Information:

I / We authorize PHH Preferred Mortgage L.L.C. to make inquiry to the participating Credit Bureau(s) to obtain my/our current credit status. I / We understand the information provided in my/our credit report will be used to determine my/our ability to qualify for a FHA / VA / Conventional mortgage through Cendant Preferred Mortgage L.L.C. By providing your name, signature, and phone number you are consenting to receive phone calls from Coldwell Banker Preferred regarding our services.