First Name:

Last Name:

* Your email address:

Pre-Qualification

Fill out the fields below. Fields marked with (*) are mandatory.

	PRIMARY PURCHASER:
First Name:*
Last Name:*
Address:*
City:*
State:*
Zip:*
Phone:*
Work:
E-mail:*
Spouse or Co-Buyer?*
	Fill out below if Co-buyer
	CO-PURCHASER/ SPOUSE:
First Name:*
Last Name:*
Address:*
City:*
State:*
Zip:*
Phone:*
Work:
E-mail:*


Financing:*
	Fill out below if Third party finacing
Lender Name:*
Lender Contact:*

	FINANCIAL INFORMATION:
Employer:*
Job Title*
Years at Job:*
Self Employed:*
If Yes, can your stated income be verified:*
Combined Gross Annual Household Income:*
What Would Your Total Down Payment Be At Purchase?*
Do You Currently Own Your Home?
Source Of Down Payment Funds:*
How Would You Rate Your Credit?*
* By registering for an Auction by AuctionHouse Real Estate Disposition Services, Inc. a bidder acknowledges having read and agreed to the Terms and Conditions in their entirety, as set forth in the auction brochure. A successful buyer will be required to acknowledge in writing that he/she/they have fully investigated and inspected the property, as well as having received and reviewed ALL disclosures relating to said property prior to bidding at the auction. I understand that this form does not constitute a loan application nor should it be construed as a commitment to make a loan.
* I consent that in the event my bid is successfully accepted, I authorize Preferred lender to provide AuctionHouse Real Estate Disposition Services, Inc. with updates on the status of my prequalification or loan request in connection with my purchase of the auctioned property. This may include without limitation, the following information: (a) whether or not I have applied for a mortgage loan; (b) whether or not a property appraisal has been ordered, scheduled or completed; (c) whether there are any conditions that must be satisfied prior to loan approval; (d) the date on which loan documents are available for my signature; (e) the estimated date the loan is expected to clear escrow, and; (f) the date on which my loan is funded.
Name:*
Date*