John Foor & James Grimm, Pelicans Nest Realty Services LLC
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PINE ISLAND FL.
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LEE COUNTY FL..
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PREQUALIFY
Borrower Information:
Borrower (Full Name):
Date of Birth:
(ex. dd/mm/yyyy)
Soc. Security #:
Residence Phone #:
Business Phone #:
Present Address:
City:
State/Province:
Zip Code/Postal Code:
E-mail Address
Years at Present Address:
Rent $
/month
or
Own $
Previous Address:
City:
State/Province:
Zip Code/Postal Code:
Marital Status:
Married
Separated
Unmarried
(including single, divorced, or widowed)
 
Occupation:
(Position & Title)
# of years:
Place of Employment:
(Name & Address)
Previous Employer:
(Name & Address)
Co-Borrower Information:
Co-Borrower (Full Name):
Date of Birth:
(ex. dd/mm/yyyy)
Soc. Security #:
Residence Phone #:
Business Phone #:
Present Address:
City:
State/Province:
Zip Code/Postal Code:
E-mail Address
Years at Present Address:
Rent $
/month
or
Own $
Previous Address:
City:
State/Province:
Zip Code/Postal Code:
Marital Status:
Married
Separated
Unmarried
(including single, divorced, or widowed)
Occupation:
(Position & Title)
# of years:
Place of Employment:
(Name & Address)
Previous Employer:
(Name & Address)
Gross Annual Income:
Borrower
Co-Borrower
Self-Employed ?
Yes
No
Yes
No
Base Salary:
$
$
Overtime:
$
$
Bonuses:
$
$
Commissions:
$
$
Dividends:
$
$
Net Rental Income:
$
$
Other:
$
$
Total:
$
$
Do You Intend To Occupy This Property ?
Yes
No
Number of Children:
Ages:
Other Dependents:
Assets:
Checking:
$
Bank:
$
Bank:
Savings:
$
Bank:
$
Bank:
Credit Union:
$
Bank:
Stocks:
$
Bonds:
$
Life Insurance:
$
Present Residence (If Owned):
Market Value:
$
Morg. Value:
$
Lender:
Other Assets (Specify):
Liabilities:
(List outstanding obligations including auto loans, mortgage payments,credit cards,
personal loans, and all other loans.)
Type
Creditor's Name
Unpaid Balance
Due Date
Monthly Payment
$
$
$
$
$
$
Total:
$
$
Additional Monthly Obligations:
Alimony:
$
Child Support:
$
Child Care:
$
Are There Any Judgements or Lawsuits Present?
Yes
No
Amount:
$
Is Any Part of the Down Payment or Settlement Costs
Being Obtained From a Source Other Than From Assets
Listed Above?
Yes
No
I hereby give my consent to have my credit report secured
from any credit reporting agency which you designate.
Yes
No
Pelicans Nest Realty Services LLC
621 Cape Coral Pkwy E Suite 19, Cape Coral, FL 33904
John Foor: 239-218-7915
James Grimm: 239-898-1728
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