Allied Home Mortgage Capital Corporation

Prequalification Form

By entering data in this form, I acknowledge and grant permission for a representative of Allied Home Mortgage Capital Corp to contact me regarding my home buying and financing needs.

The information you provide here will be used in determining the amount of mortgage for which you can qualify. This information will be transmitted via our secure server. Fields marked with an asterisk (

) indicates it is required information.

Name:

Social Security:

Email:

Address 1:

Address 2:

City:

State:

Zip:

Phone 1:

Phone 2:

Fax:

Preferred Call Time:

I want the...

Purpose of Loan:

Estimated Property Value:

Estimated Loan Amount:

Amount Owed on Current Property:

What is your current rate?:

Property State:

Property City:

Annual Property Taxes:

Annual Homeowners Insurance:

Annual Income:

Available Cash On Hand:

Estimated Closing Date:

Have you already located a house? Yes No

If this is for a refinance please tell us the number of years you expect to be in your house:

May we obtain your credit information in order to pre-qualify you for a loan: Yes No

Are you using a realtor? Yes No

Realtor's Name:

Realtor's Company:

Realtor's Phone:

Realtor's Email:

Additional Information:

Did someone from our office refer you? If so, please enter his or her name in the space provided here.

If you are already working with someone from our office, please enter their name here:

How did you hear about our website?:

If "other" was selected, please specify:

Please take a moment to tell us your goal for this loan. For example: "I'm looking for a 30-year fixed rate with the lowest down possible". This helps us in determining the best loan program:

This information is being used as a prequalification only and is not an application for credit. In connection with my prequalification, I authorize Allied Home Mortgage Capital Corporation to do an in-file credit report if they so choose. By submitting this form, I agree to accept calls regarding mortgage services offered by AHMCC.

Submitting this form does not obligate you to accept a loan should you be approved, and it does not constitute a rate lock with Allied Home Mortgage Capital Corporation, (AHMCC). The information submitted will remain confidential and will only be used by AHMCC to determine the best loan program for you.

Yes No

I choose to have my information shared with third parties or affiliated companies, except as may be required for the purpose it was submitted and where required by state and federal law. Third parties and affiliated companies may include companies with whom Allied has an established relationship to provide you with additional services or products.

Home New Purchase Refinance Home Equity Debt Consolidation About Us

Allied Home Mortgage Capital Corporation

8727 Belair Road

Perry Hall, Maryland 21236