Borrower Name: Marital Status: Single Married

Date of Birth: January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 1213 14 15 16 17 18 19 20 21 22 2324 25 26 27 28 2930 31 1906 1907 1908 1909 1910 19111912 1913 1914 1915 1916 1917 19181919 1920 1921 1922 1923 1924 1925 1926 1927 1928 19291930 1931 1932 1933 1934 19351936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 19491950 1951 1952 1953 1954 1955 1956 1957 1958 19591960 1961 1962 1963 1964 1965 1966 1967 19681969 1970 1971 1972 1973 1974 1975 1976 19771978 1979 1980 1981 1982 1983 1984 1985 1986 1987 19881989 1990 Phone Number:

Co-Borrower Name: Marital Status: Single Married

Date of Birth: January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 1213 14 15 16 17 18 19 20 21 22 2324 25 26 27 28 2930 31 1906 1907 1908 1909 1910 19111912 1913 1914 1915 1916 1917 19181919 1920 1921 1922 1923 1924 1925 1926 1927 1928 19291930 1931 1932 1933 1934 19351936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 19491950 1951 1952 1953 1954 1955 1956 1957 1958 19591960 1961 1962 1963 1964 1965 1966 1967 19681969 1970 1971 1972 1973 1974 1975 1976 19771978 1979 1980 1981 1982 1983 1984 1985 1986 1987 19881989 1990 Phone Number:

Best Time to Contact: Morning AfternoonEvening

E-Mail Address:

Residence History (Please show 2 year Residence History)

Current Address:

How Long:OwnRent

Previous Address:

How Long:OwnRent

Employment History

Borrower Current Employer:

How Long:Gross Pay

Borrower Previous Employer:

How Long:Gross Pay:

Co-Borrower Current Employer:

How Long:Gross Pay:

Co-Borrower Previous Employer:

How Long:Gross Pay:

Other Income (Please Explain):

Assets

Checking Account (Bank):Average Balance:

Savings Account (Bank):Average Balance:

Retirement, 401k, etc:Average Balance:

Current Liabilities

Mortgage Loan(s):

Car Loan(s):

Credit Card(s):

Other:

Desired Loan Amount:Purpose:RefinancePurchase

Are you working with a realtor?YesNo

Information given to Salt City Mortgage, LLC is held confidential and will not be shared with anyone except the loan applicant(s). I understand that this pre-qualification request does not circumvent the need for a written mortgage loan application. Any information provided by Salt City Mortgage, LLC regarding loan amount is subject to an acceptable appraisal and verification of all data provided by me. I under stand this online application does not guarantee a commitment to make a loan. All loans are subject to credit approval. Rates, terms and conditions are subject to change without notice. Please call for most recent rates and programs.