West Town Bank Pre-Qualification Form

Please take a moment to tell us about yourself
and your mortgage needs. All of this information is extremely
important during the pre-qualification stage so be sure to fill it out as
completely and accuartely as possible.

Once this form has been completed, you will recieve an email from us
that will include a borrower's authorization form. This form will need
to be signed and faxed back to us immediately so that we can pull
your credit. After the credit report has been pulled, someone from the
Tammy Belcher Team will contact you and go over the credit report
with you and discuss your mortgage needs in more detail.

Feel free to contact the Tammy Belcher at 804-855-7202 directly with
any
questions and or concerns that you may have about this process.
 
Your loan needs (Enter NA if not applicable)
*Reason for loan (purch, refi, build):
*Do you already own the land to build on?:
*Est. Market Value of Land:
*What State and County is the land located in:
*Est.Cost to build:
*Purchase price of home:

Personal Information (Enter NA if not applicable)
*Name:
*Email:
*Phone:
*Birthdate:
*Monthly Income - Borrower :
*Address:
Co-Borrower Name:
Email :
Phone:
Birthdate:
Monthly Income - Co-Borrower:

Who referred you to us
*Sales agents name:
Sales agents phone number:
Sales agents email address:
*Name of company:

Note: Fields with an * are required


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