Corporate NMLS #179785
Branch NMLS #179785

Thank you for contacting
SouthShore Region Mortgage
Please fill out our Pre-Qualification form below.
Your data is secure and protected.


Purpose of this loan?


Property type?





How will this property be used?




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

Current Address

Living Details

Birth Date

Social Security Number

Employment Section




Employed

Please add your employment information below

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

Self Employed

Any Additional Monthly Income?


Assets

+ add additional 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 applying with another borrower or co-borrower?


Are you married to the Co-borrower?


Co-borrower Details

Co-borrower address the same as borrower?


Co-borrower address

Living Details

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

Birth Date

Social Security Number

Employment Section




Employed

Please add your employment information below

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

Self Employed

Any Additional Monthly Income?


Any assets not already listed by the borrower?


Additional Real Estate Owned

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


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?


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?


Are you married to a co-borrower?

How did you hear about us?

Authorization

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

Thanks

Thanks

SouthShore Region Mortgage
MLO - Steve Stasny
NMLS #142945

9111 Broadway
Suite H
Merrillville, IN 46410
Business Phone: (866) 773-4466
Cell Phone: (219) 789-1551
Fax: (219) 472-8656
Website: www.southshoreregion.mortgage
Email: Steve@SouthShoreRegion.Mortgage

NMLS Consumer Access

Copyright © 2021 | SouthShore Region Mortgage Licensed to Do Business in the State of CO, FL, IL, IN, MI, MN & WI | NMLS # 179785 Copyright © 2021 American Fidelity Mortgage Services Inc. Illinois Mortgage Licensee License # MB 0000303 NMLS# 179785 Indiana Department of Financial Institutions (DFI) License ID Number 11229 American Fidelity Mortgage Services, Inc. also does business as SouthShore Region Mortgage in the State of Indiana State of Wisconsin - Department of Financial Institutions License #159BA In the State of Illinois Mortgage Bankers are governed by: IL Department of Financial & Professional Regulation Division of Banking 122 South Michigan Ave., Suite 1900, Chicago, IL 60603 Phone: (312) 793-3000 Fax: (312) 793-7097 Web: http://www.idfpr.com/default.asp Toll Free Consumer Hot Line: (877) 793-3470