PRE-APPLICATION FORM

PREMIER MORTGAGE FUNDING USA, INC.
Corporate address: 2575 Ulmerton Road, Suite 250, Clearwater, Fl 33762
Branch Manager: Marsha Deane, 244 Glory Road, Quincy, FL 32352
Office 850-875-2240  Cell # 850-545-0418  Home 850-875-3544 E-mail: mjhdeane@aim.com

For a FREE estimate, complete and mail this form to Marsha Deane, Branch Manager. There is no obligation!

Name of Borrower_____________________________________________________Social Security Number_____________________

Employer____________________________________________________________________________________________________

Years on job_______Gross Monthly Income $__________________________________Birthdate____________________

Name of Co-Borrower__________________________________________________Social Security Number_____________________

Employer_____________________________________________________________________________________________

Years on job_______Gross Monthly Income $_________________________________Birthdate_____________________

Property Address_______________________________________________________________________________________

City_____________________________________________________State_______________________Zipcode____________

Years at Property______ Daytime Phone____________________Nighttime Phone______________________

E-mail address______________________________________________

Loan Amount Requested $_____________________________________□ Fixed      □ Adjustable  □ Term (if fixed)

Approximate value of your home $____________________________________________________________

If you are requesting funds to refinance an existing loan, please complete the following:

Balance on 1st mortgage $________________________Rate_______________________Term_______________________

Monthly payment (principle and interest only)_______________________________________________________________

Balance on 2nd mortgage_________________________Rate_______________________Term_______________________

Monthly payment (principle and interest only)_______________________________________________________________

Authorization to release Credit Information
I hereby authorize Premier Mortgage Funding USA, Inc. to obtain my/our credits report(s) and/or additional information to determine credit worthiness. This information is strictly confidential. A photocopy of facsimile of this authorization may be determined to be an equivalent of the original.

Borrower's Signature_____________________________________________________________Date______________________

Co-Borrower's Signature__________________________________________________________Date______________________