<%@ Language=VBScript %> MortgageNet@Work Prequalification-- Get the right mortgage at the lowest price.
MortgageNet@Work specializing in debt consolidation and home improvement loans, educating the consumer with simple, straightforward facts. MortgageNet@Work educating the consumer on the basic facts about debt consolidation and home improvement loans.
Loan Information and Purpose of Loan (Items marked with " * " are required for submission.)
Estimated Value of Home:
Purpose of Loan:*
If purpose of loan is other, please explain below:
Loan Amount Desired:
Borrower Information
I.  Borrower's Name: (include Jr. or Sr. if applicable)
First Name:* Middle Name: Last Name:*
Email Address:
 		Social Security #*

  - -

Home Phone*
(incl. area code) 

( ) -

Present Address (street, city, state ZIP): Own *    Rent* Number of Years*
Street:*
City:*
 State:*
(Abvr.)		 Zip Code:*
Gross Monthly Income*

II.  Co-borrower's name: (include Jr. or Sr. if applicable)  Do you have a CoBorrower

First Name:

Middle Name:

Last Name:
Email Address:
 		Social Security # 

  - -

Home Phone
(incl. area code)

( ) -

   
Present Address (street, city, state, ZIP): Own     Rent      Number of Years
Street:
City:
 State:
(Abvr.)		 Zip Code:
Gross Monthly Income

Authorization to Release Information*  You are free to disagree or agree with the acknowledgment below, however, please understand that if select 'DISAGREE' that your application automatically cannot be processed or pre-approved.
I authorize MORTGAGENET.WORK to verify any and all information that is needed to complete the loan process. Such information includes, but is not limited to, employment history and income; bank, money market and similar account balances; credit history; and copies of income tax returns.
 
I Agree    I Disagree
Additional Information
When would you like us to contact you:* Explain When to Contact :
How did you hear about us?*
If you answered, 'G, H, or I' to the above question, please specify the first and last name of the contact person who referred you to MORTGAGENET.WORK in the box on the right to ensure that proper credit is given to the appropriate loan originator.
  
Borrower/Co-borrower Signatures
Borrower's Signature*
 Type in Name

_________________________________________________

Date
Co-borrower's Signature*
 Type in Name

_________________________________________________

Date