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Preferred Loan Officer (Leave blank if you do not have a preference)
General Information
How did you hear about us?
If Employee Referral, Enter Employee Name:
How soon are you looking to buy/build/refinance?
How do you prefer to be contacted? Phone
E-mail
Either
What time of day do you prefer to be contacted? Morning
Afternoon
Either
Is there a co-borrower for this mortgage loan? Yes
No
Primary Borrower Information
First Name*
Middle Name or Ml
Last Name*
Suffix (Jr., Sr., M.D.)
Home Phone Number*
(xxx-xxx-xxxx)
Cell Phone Number
(xxx-xxx-xxxx)
E-mail Address*
yourname@domain.com
Social Security Number*
(xxx-xx-xxxx)
Date of Birth*
(xx/xx/xxxx)
Street Address*
City*
State*
Zip Code*
Years at Current Address*
Mailing Address (if different than Street Address)
Mailing Address
City
State
Zip Code
Primary Borrower Employment Information
Place of Employment*
Time with Employer Years
Months
Occupation*
Annual Gross Income* $
Other Income (See Notice Below) $
Notice: Alimony, child support, or separate maintenance income need not be revealed if the Borrower does not choose to have it considered for repaying this loan.
Co-Borrower Information

Please check the joint credit box below for co-borrower information to be considered for this prequalification.

First Name*
Middle Name or Ml
Last Name*
Suffix (Jr., Sr., M.D.)
Home Phone Number*
(xxx-xxx-xxxx)
Cell Phone Number
(xxx-xxx-xxxx)
E-mail Address*
yourname@domain.com
Social Security Number*
(xxx-xx-xxxx)
Date of Birth*
(xx/xx/xxxx)
Street Address*
City*
State*
Zip Code*
Years at Current Address*
Mailing Address (if different than Street Address)
Mailing Address
City
State
Zip Code
Co-Borrower Employment Information
Place of Employment*
Time with Employer Years
Months
Occupation*
Annual Gross Income* $
Other Income (See Notice Below) $
Notice: Alimony, child support, or separate maintenance income need not be revealed if the Borrower does not choose to have it considered for repaying this loan.
Primary Borrower Asset Account Information
Approx. Total Balance of Checking, Savings, etc.* $
Approx. Total Balance of 401Ks and IRAs $
Approx. Total Balance of Stocks and Bonds $
How much will you contribute towards closing costs/down payment $
Co-Borrower Asset Account Information
Approx. Total Balance of Checking, Savings, etc.* $
Approx. Total Balance of 401Ks and IRAs $
Approx. Total Balance of Stocks and Bonds $
How much will you contribute towards closing costs/down payment $
Other Information
Please briefly describe any special circumstances that may affect your application (bankruptcy, payment or receipt of alimony and/or child support, investment property income, etc.)
Are there any types of "specialty" mortgage options you are interested in?
Enter the security code:
Permission to Obtain Credit Report
In order to provide an accurate estimate, Georgia Bank & Trust needs to access your merged credit report. By submitting this form you provide consent for Georgia Bank & Trust to obtain a credit report from a credit reporting agency.
By submitting this application you authorize Georgia Bank & Trust to have a credit reporting agency prepare a consumer credit report on you and any co-borrowers listed.