PHM Financial Services

Broker Information

*Company Name:

*Company Phone:

*Company Fax:

*Contact:

*Email:

Borrower

Borrower:

Co-Borrower:

First-Time Homebuyer?

Can You Verify a 24 Month VOR?

Subject Property

Purchase or Refinance:

Amount of C/O:

Property:

Escrow Waiver:

Occupancy:

Sale Price:

Property Address:

City:

State:

Zip:

Appraised Value:

Seller Consessions:

Mortgage Information

Loan Amounts:

1st:	$
2nd:	$

Expected Rate:

Expected Premium:

Doc:

Expected Close Date:

Combo:

Assets Will Be Verified At:

Loan Type:

ARM Type:

Interest Only If Available?

LTV:

CLTV:

Seasoning

Original Purchase Date:

Original Purchase Price:

Credit History

Scores:

Experian:	/
Trasnsunion:	/
Equifax:	/
MID:	/

Bankruptcy History:

Chapter 7:

Chapter 13:

Comments:

This pre-qual form will be used to get you a pricing quote in 24 hours or less. In order to continue with your loan, we will also need you to fax a 1008/1003 and credit report to 303-799-7411.