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Personal Banking - Mortgage Pre-Qualification Form

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By completing this short pre-qualification form, your loan officer will communicate the maximum loan amount for which you may qualify based on the information you supply about income, assets, and credit standing. This form is not a full loan application and therefore does not represent a loan commitment to you.

USA PATRIOT ACT NOTICE


IMPORTANT APPLICANT INFORMATION

To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account or requests a loan.

WHAT THIS MEANS FOR YOU

When you open an account, we will ask you for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.

CHILDREN'S ONLINE PRIVACY PROTECTION ACT NOTICE

I AM 18 YEARS OR OLDER

In compliance with the Children's Online Privacy Protection Act (COPPA), effective April 21, 2000, Heartland Community Bank does not intentionally market our online products to children under the age of 13, or knowingly collect personal information from children under the age of 13. We do not solicit data from children and we do not share such information with third parties. We recognize that protecting children's identities and privacy online is important and that the responsibility to do so rests with the online industry and the parents. You must be 18 years old to enter into a valid contract. For more information about COPPA, visit the Federal Trade Commission at www.ftc.gov

By clicking on the "I agree" button below, you:

  • Acknowledge that you are able to access information provided via the Internet.
  • Acknowledge receipt of the US Patriot Act Notice.

 I Agree

Tell Us About Yourself

*First Name:

 

* Last Name:

 

* Email Address:

 

* Day Phone:

- -   EXT:

 

Evening Phone:

- -    EXT:

 

Cell Phone:

 -  -  

 

Street Address:
 

City:

 

State:

 

Zip:

 

Tell Us About Your Co-Borrower (If Applicable)

First Name:

 

Last Name:

 

Email Address:

 

Street Address:

 

City:

 

State:

 

Zip:

 

Day Phone:

-   -  EXT:

 

Evening Phone:

-   -  EXT:

 

What Kind of Loan are You Looking For?

*Desired Loan Type:

 

* Desired Term:

 

* How soon do you need:

 

* Desired Property Type:

 

* Property Value or Purchase Price:

 

Current Loan Information (Please skip if no mortgage)

Amount Owed:

 

Current Interest Rate:

 

Fixed or Variable Rate:

 

How long have you had this loan?
 

Current Monthly Payment:

 

Have you been late on your mortgage?

 

Employment & Credit Information: Primary Borrower

* Gross Monthly Income:

 

* Time at current job?:

 

Monthly Rent (If renting):

 

* Total "other" monthly debts:
(Excluding mortgage payment and utilities)

 

Rate your Credit: *

 

Employment & Credit Information: Co-Borrower

Gross Monthly Income:

 

Time at current job?:

 

Rate your Credit:

 

Comments

*Required

By submitting your application, you are authorizing HEARTLAND Community Bank to obtain a credit report. All non-public information you provide will be protected per our privacy policy. A representative from HEARTLAND Community Bank will contact you by telephone regarding this pre-qualification form. By submitting your expression of interest, you are consenting to receive telephone calls from HEARTLAND Community Bank.