Purchase

Refinance

Investment

Borrower Information

Last Name/ First Name/ M.I.

Marital Status

Current Address

City / State / Zip

Length At Present Address

Years

Months

Job Title / Position

Were you employed by more than 2 employers in the past 2 years?

Yes

No

Please provide additional employment information for the past two years. (Check as applicable)

Have they been in the same line of work?

Were there gaps of employment of more than one month?

If you answered yes to any of the above, please give a detailed explanation

Disclosure Statement

Under Reg. (Z) of the Real Estate Settlement Procedure Act (RESPA), a Truth-in-Lending Disclosure Statement must be sent to the applicant within 3 days after the application has been taken. I/We understand completely that we are only applying for a pre-approval of a loan amount, and not a Real Estate Mortgage at this time, and that a Truth-in-Lending disclosure will be forwarded within 3 days of a formal mortgage application.

By checking one of the following you are agreeing that you understand the terms and conditions of this pre-approval application.

Yes, I/we agree and understand these terms and conditions

No

Monthly Earnings

(Alimony, child support or separate maintenance does not need to be revealed f you do not want it considered by the creditor in determining creditworthiness.)

Easy Pre-Approval Application

Home Phone / Work Phone

Social Security Number

Licensed by the Pennsylvania Department of Banking and the Ohio Department of Commerce.

American Capital Mortgage, inc.

2233 Ebco Drive

Suite 1 - West Entrance

Erie, PA 16506

Quality People / Exceptional Service

Mortgage, inc.

Capital

Borrower

Co-Borrower

Base Employment Income

Overtime*

Bonuses*

Other Income

Mortgage Program