Sandra Bazak

Pre-Qualification Form

Please either complete the online form or print and fill out the Printer Friendly Version.

Mail the PDF or HTML to: Sandra Bazak, 911 N. Buffalo, Ste. #213, Las Vegas, NV 89128
Borrower
Co-Borrower
Name:
Co-borrower Name:
Date Of Birth:
Co-borrower Date Of Birth:
SSN:
Co-borrower SSN:
Address:: Co-borrower Address::
How long have you lived
at the above address?:
Co-borrower length at the
above address?:
Do you Own or Rent?:
Co-borrower Own or Rent?:
Is Home Listed:
Co-borrower Home Listed
Marital Status:
Co-borrower Marital Status:
Number of Dependants:
Co-borrower # of Dependants:
Employers Name:
Co-borrower Employers Name:
Work Address:
Co-borrower Work Address:
Date of Hire:
Co-borrower Date of Hire:
Borrower Monthly Gross
Income:
Co-borrower Monthly Gross Income:
Job Title:
Co-borrower Job Title:
Borrower Amount of
Anticipated Down Payment:
Co-borrower Amount of Anticipated Down Payment:
Holder of Assets and
Dollar Amount:
Co-borrower Holder of Assets and Dollar Amount:
Anticipated Move Date:
Co-borrower Anticipated
Move Date:
Anticipated Price Range:
Co-borrower Anticipated
Price Range:
Preferred Contact Method
(Phone, Fax, Email):
Co-borrower Preferred Contact Method (Phone, Fax, Email):
Contact Person:
Contact Number
or Address: