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Mortgage Loan Prequalification Application
Protecting your Privacy

We are committed to protecting your privacy. The information that you furnish to us will be used to provide you with the products and services you are requesting. We restrict access to information about you to those employees who need to know that information to provide products or services to you. For more information please read our Privacy Statement under the heading of Privacy & Security.

Mortgage Loan Prequalification Application*Indicates a Required Field
(Offered to customers 18 years of age or older.)
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
I Will Contact You
What time of day do you prefer to be contacted? Morning
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*
Cell Phone Number
E-mail Address
Social Security Number*
Date of Birth*
Street Address*
Zip Code*
Years at Current Address*
Mailing Address (if different than Street Address)
Mailing Address
Zip Code
Primary Borrower Employment Information
Place of Employment*
Time with Employer Years Months
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 $
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?
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.

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