Instructions:
Please complete this form with as much information as possilbe to allow the mortgage specialist to better assist you.
Then click submit to send it Prudential LeClair & Associates Realty.
This form will then be sent to a mortgage specialist.

House Purchase Information:
If you don't have a house in mind and would like to get pre approval only select the amount from the Pre-Approved box and the amount of the Down payment.

Select a LeClair Listing	Keep as Pre Approval Only
Estimated House Price	From $0$75,000$125,000$175,000$225,000$275,000$325,000 To $0$124,999$174,999$224,999$274,999$324,999$325,000 +
Down Payment	From $0$1$5,000$10,000$15,000$20,000$25,000$30,000$35,000$40,000$45,000$50,000$55,000$60,000$65,000$70,000$75,000 To $0$4,999$9,999$14,999$19,999$24,999$29,999$34,999$39,999$44,999$49,999$54,999$59,999$64,999$69,999$74,999$75,000 + Or a percentage: 0%5%10%15%20%25%30%35%40%45%50%50% +

Borrower Information:

	Borrower	Co-Borrower
First Name
Last Name
Phone
Email Address
Best Contact (refers to Phone above)	Cell PhoneEmailHome PhoneWork Phone	Cell PhoneEmailHome PhoneWork Phone
Address - Unit	-	-
City, Prov	,	,
Postal
Own / Rent	RentOwn	RentOwn
Years there
Employer
Occupation
Pay Type	HourlyCommissionSalarySalary + CommissionSelf Employed	CommissionHourlySalarySalary + CommissionSelf Employed
Amount	AnnuallyHourlyMonthly	AnnuallyHourlyMonthly
Hours per week (if paid Hourly)
Have you declared bankruptcy within the past 6 years?	NoYes	NoYes
How is your credit?	ExcellentGoodAveragePoorUnknown	ExcellentGoodAveragePoorUnknown

Cars / RV / Boats / Other Leisure Vechicles & Associated Loan

Cars / RV / Boats / Other Leisure Vechicles					Associated Loan
Type	Year	Make	Model	Current Value	Type	$ Owing	$ Mthly	Paying Off? *
BoatCarOtherRV					LeaseLoanNone			NoYes
BoatCarOtherRV					LeaseLoanNone			NoYes
BoatCarOtherRV					LeaseLoanNone			NoYes
BoatCarOtherRV					LeaseLoanNone			NoYes

Credit Cards / Loan / Lines of Credit

Type	Balance Owing	Monthly Payment	Paying Off? *
AmexLine of CreditLoanMasterCardVisa			NoYes
AmexLine of CreditLoanMasterCardVisa			NoYes
AmexLine of CreditLoanMasterCardVisa			NoYes
AmexLine of CreditLoanMasterCardVisa			NoYes

* Do you plan on paying off the balance before you move into you new home?

There will be no credit verification completed which could effect your ability to secure a mortgage.

Enter the code as shown above