Andover Mortgage Corp. Serves Massachusetts and New Hampshire



Andover Mortgage 855 Turnpike Street North Andover, MA 01845 ph: 978.974.0000 fax: 978.974.9199 ©1999-2010 Andover Mortgage Corp. All Rights Reserved Andover Mortgage Corporation Corporate License: NMLS #2116 Richard Roda Loan Originator: NMLS #12801 Massachusetts License: #MB 2733 Licensed by the New Hampshire banking department to broker first mortgages: #10136-MBR

Pre-Qualification Instructions

Andover Mortgage Corporation operates in the following states:
Massachusetts and New Hampshire.

Complete this form if you wish to request mortgage information. Fill in as many fields as possible and then click the "submit" button. This form will be sent to AMC, but you should follow up with a phone call at 978-974-0000 to obtain the status of your request.

Borrower Information

	Borrower	Co-Borrower
Full Name:
Address:
City, State, Zip:
Home Phone:
Work Phone:
Best time to Call:
Email Address:
Social Security Number:
Employer's Name:
Address:
City, State, Zip:
Phone:
Are you self employed?	Yes No	Yes No
Length of Employment:
Gross Monthly Income:
Date of Birth:

My Credit History is:

My Credit Histor is:

Loan Requests

Amount Requested:
Type of Loan:
Purpose of Loan:
Amortization Type:

Property Information (property to be used for collateral for loan.)

Street Address:
City, State, Zip:
County:
Estimated Present Value:
Date/Year Purchased:
Original Price:
Type of Property

Liability Information

Mortgage Balance	Held By	Monthly Payment
#1 ($)		$
#2 ($)		$
#3 ($)		$
Creditors	Amount Owed	Monthly Payment
	$	$
	$	$
	$	$

Other Monthly debts and information - give brief description.

By submitting this online pre-qualify appliation, I/We authorize Andover Mortgage Corporation to check on My/Our credit status/history, employment and/or business status and histories.