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Here is the sample of free Pre-Qualification Application
from I'm Not Leaving.com

Pre-Qualification Application

If a question does not apply please leave blank. General Information First Name * Last Name * Spouse First Name Spouse Last Name Referred By Address Information Address Line 1 * Address Line 2 City * State Select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Other - Non-US Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming * Zip * Contact Information Phone Number * Alternate Phone Number Email Address * Alternate Email Address Preferred Contact Method Phone Email Subject Property Same as Contact Address? Address Line 1 * Address Line 2 City * State Select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Ontario - Canada Oregon Other - Non-US Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming * Zip *

Employment Information Employer * Years in Current Job * Work Phone * Job Title Part Time Employer Years in Part Time Job Spouse Employer Spouse's Years in Job Work Phone Spouse's Job Title Spouse's Part Time Employer Spouse's Years in Part Time Job Number of Dependents * Dependent Ages (0=none) * Mortgage Information 1st Mortgage Lender * Mortgage Loan Type * Mortgage Loan Number * 1st Mortgage Interest Rate * Months Behind * 2nd Mortgage Lender 2nd Mortgage Loan Type 2nd Mortgage Loan Number 2nd Mortgage Interest Rate # of Liens on Property Total Lien Amount Owed Months Behind Purchase Price 1st Mortgage Owed / Balance * 2nd Mortgage Owed / Balance * Date Purchased Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 * Current Estimated Home Value Foreclosure Lawyer Foreclosure Lawyer Phone Number Foreclosure Hearing Date Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2009 2008 2007 2006 2005 2004 2003 1st Mortgage Foreclosure Sale Date Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2009 2008 2007 2006 2005 2004 2003 2nd Mortgage Foreclosure Sale Date Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2009 2008 2007 2006 2005 2004 2003 Hardship ------- Select ------- Payment Increase Rate Increase Job Loss Separation/ Divorce Medical Death Other Detailed Reason Behind

Income Information Borrower's Monthly Take Home Pay Spouse's Monthly Take Home Pay Other Monthly Income Other Monthly Income Description Est. Avg. Future Monthly Income Cash on Hand for Negotiation Expenses Information Rent or Home Mortgage Payment * 2nd Rent or Home Mortgage Pmt. Electricity Bill Heating Bill Water / Sanitation Bill Telephone Bill Newspapers, Periodicals, Books Medical and Drug Expenses Auto Insurance Homeowner's Insurance Cable Television Transportation (Gas, Bus, Cab) Monthly Property Taxes Alimony, Maintenance, or Support Child Care, College, School Tuition Clothing Laundry and Cleaning Religious and/or Charity Automobile Payments Misc. Creditors Total Monthly Pmts. Chapter 13 Payment Food (groceries, dining)

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