Apply for a Home Loan with Northwest Mortgage, at any of their locations of Coeur d'Alene, Sandpoint, Lewiston, Missoula & Whitefish

1. Complete the following borrower and co-borrower information if applicable.

Borrower Information:
Name:
Employer:	Job 2+ years Yes No
Gross Monthly Income:
Date of Birth:
Address:
City:	State: Zip:
Home Phone:
Alt. Phone
Monthly Debt:
Co-Borrower Info
Name:
Employer:	Job 2+ years Yes No
Gross Monthly Income:
Date of Birth:
Address:
City:	State: Zip:
Home Phone:
Alt. Phone:
Monthly Debt:

2. Complete either the Home Purchase OR Refinance section below.

Home Purchase
Home type:
Purchase Price:
Loan amount requested:

Refinance
Current Home Value:
First mortgage balance:	Rate:
Monthly Payment:
Lender:
Second mortgage balance:	Rate:
Monthly Payment:
Lender:

3. Complete Credit Information section below.

Credit Information

Credit Rating:

If you do not know your credit rating, please use the following section to let us know about any credit issues that you may have such as a bankruptcy, liens, etc.

4. Let us know any other additional information that may help assess your situation.

Additional Information

Disclaimer

I understand that the information collected here is for prequalification purposes only to help determine my eligibility for a loan and does not constitute a loan application with Northwest Mortgage, nor a loan approval of any kind.

I understand that by submitting this form I am NOT applying for credit with Northwest Mortgage and am under no obligation to apply for credit in the future.

I understand that I will be contacted by a representative from Northwest Mortgage regarding this request for information.

You must read and agree to the above disclaimer prior to submitting this form.
Please type "yes" into the box below to verify that you have read and agree to the disclaimer.

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