Fluxx Mortgage & Financial, LLC - Mortgage Pre-Qualification Form

Purpose of this loan?

Purchase
Refinance
HELOC

Property type?

Single Family Home
Townhome
Multi Family Home
Condominium
Manufactured Home

How will this property be used?

Primary Residence
Second Home
Investment Property
Mixed-Use

Mixed-Use: if you will occupy the property, will you set aside space within the property to operate your own business? (e.g., daycare facility, medical office, beauty/barber shop)

Borrower Information

We will gather some basic information about you and your mortgage needs to help find you the best available options there are.

Contact Information

By clicking "Next" you agree to receive calls, emails, SMS, or texts from Fluxx Mortgage & Financial, LLC according to the Software Terms of Use and Privacy Policy. You also agree to receive documents electronically.

Current Address

Living Details

Birth Date

Social Security Number

Employment Section

Employed
Self Employed
Unemployed
Retired

Employed

Please add your employment information below

Employer Name

Start Date

Gross Monthly Income Do not include bonuses, overtime, or commission, this will be added later.

Address

City

State

Zip

Phone

Position/Title

Self Employed

Business Name or DBA

Start Date

Gross Monthly Income

Address

City

State

Zip

Phone

Position/Title

Any Additional Monthly Income?

Yes
No

Additional Monthly Income

Now lets answer some questions about income.

Notice: Alimony, Child Support or Separate Maintenance income need not be revealed if the borrower does not choose to have it considered for repaying this loan.

Source of Income

Additional Income Name

Additional Monthly Income

+ add additional income + add additional income + add additional income + add additional income

Assets

Asset Type

Asset Name

Balance

+ add additional assets + add additional assets + add additional assets + add additional assets

Additional Real Estate Owned

Yes
No

Additional Real Estate Owned

Additional Details (Marital Status)

Married
Unmarried
Separated

Do you pay child support or alimony?

Yes
No

How Much Per Month

Are You a Veteran?

Yes
No

How Many Dependents?

First Time Home Buyer?

Yes
No

Add Co-borrower?

Are you applying with another borrower or co-borrower?

Yes
No

Are you married to the Co-borrower?

Yes
No

Co-borrower Details

Co-borrower address the same as borrower?

Yes
No

Co-borrower address

Living Details

How long has the co-borrower lived at the current address?

Birth Date

Social Security Number

Employment Section

Employed
Self Employed
Unemployed
Retired

Employed

Please add your employment information below

Employer Name

Start Date

Gross Monthly Income Do not include bonuses, overtime, or commission, this will be added later.

Self Employed

Business Name or DBA

Start Date

Gross Monthly Income

Any Additional Monthly Income?

Yes
No

Additional Monthly Income

Now lets answer some questions about income.

Notice: Alimony, Child Support or Separate Maintenance income need not be revealed if the borrower does not choose to have it considered for repaying this loan.

Source of Income

Additional Income Name

Additional Monthly Income

+ add additional income + add additional income + add additional income + add additional income

Any assets not already listed by the borrower?

Yes
No

Any assets not already listed by the borrower?

Asset Type

Asset Name

Balance

+ add additional assets + add additional assets + add additional assets + add additional assets

Additional Real Estate Owned

Does the co-borrower have any real estate owned not already listed by the borrower?

Yes
No

Additional Real Estate Owned

Does co-borrower pay child support or alimony?

Yes
No

How Much Per Month

Are You a Veteran?

Yes
No

How Many Dependents?

First Time Home Buyer?

Yes
No

Notice: Upon submission of your prequal form, each co-borrower added will receive an email with the subject "FIRST_NAME LAST_NAME Toolbox Link" (if not found check spam folder). Co-Borrowers can use the toolbox link to complete their portion of the prequal form OR you can complete their portion by following the next steps. Please DO NOT have the co-borrowers fill out a new prequal form.

Each co-borrower will have to sign their own credit authorization from their own toolbox. If the email is not found in the inbox, please check the spam folder.

Are you married to a co-borrower?

Yes
No

Are you married to a co-borrower?

How did you hear about us?

Authorization

agree to PreApp LLC Software Terms of Use and Privacy Policy. also agree to Fluxx Mortgage & Financial, LLC eDisclosure and eSignature Credit Authorization agreements. I authorize by my Electronic Signature below, for Fluxx Mortgage & Financial, LLC to obtain a credit report. I also understand and consent that my Social Security Number may be used to digitally verify income/employment/assets.

Purpose of this loan?

Property type?

How will this property be used?

Loan Information

Borrower Information

Contact Information

Current Address

Living Details

Birth Date

Social Security Number

Employment Section

Employed

Self Employed

Any Additional Monthly Income?

Additional Monthly Income

Assets

Additional Real Estate Owned

Additional Real Estate Owned

Additional Details (Marital Status)

Do you pay child support or alimony?

How Much Per Month

Are You a Veteran?

How Many Dependents?

First Time Home Buyer?

Add Co-borrower?

Are you married to the Co-borrower?

Co-borrower Details

Co-borrower address the same as borrower?

Co-borrower address

Living Details

Birth Date

Social Security Number

Employment Section

Employed

Self Employed

Any Additional Monthly Income?

Additional Monthly Income

Any assets not already listed by the borrower?

Any assets not already listed by the borrower?

Additional Real Estate Owned

Additional Real Estate Owned

Does co-borrower pay child support or alimony?

How Much Per Month

Are You a Veteran?

How Many Dependents?

First Time Home Buyer?

Co-borrowers Info

Are you married to a co-borrower?

Are you married to a co-borrower?

How did you hear about us?

Authorization

Thanks

Thanks