Owner-Occupied Duplex Mortgage Prequalification Questionnaire

Applicant Full Name

First NameLast Name

Email Address

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Current Residential Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Property Address of Duplex (if different from current address)

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Estimated Purchase Price or Value of Duplex

Will you occupy one unit of the duplex as your primary residence?

Employment Status

Monthly Gross Income (before taxes)

Total Assets (savings, investments, etc.)

Total Monthly Debt Payments (loans, credit cards, etc.)

Is there a co-applicant?

If yes, please provide the co-applicant's full name

First NameLast Name

Please provide any additional information relevant to your application (optional)