7 Heritage Oak Lane Suite #5
Battle Creek, Michigan 49015
Phone: (800) 663-3638
Fax: (800) 663-6638

PREQUALIFICATION AUTHORIZATION FORM

BORROWER

CO-BORROWER

__________________________________________
____________________________________________

Complete Legal Name
Complete Legal Name

__________________________________________
____________________________________________

Social Security Number
Age
Social Security Number
Age

__________________________________________
____________________________________________

Address                            City/State       Zip
Address                            City/State       Zip

_________________________________________
____________________________________________

Home Phone
Work Phone
Home Phone
Work Phone

Self Employed   (Please Circle)    Yes    No
Self Employed   (Please Circle)    Yes    No

_________________________________________
____________________________________________

Employer Position / Title Employer Position / Title

Years on Job ______
Years in line of Work _____
Years on Job _____
Years in line of Work _____

Gross Monthly Income   ____________________
Gross Monthly Income   _______________________

Other Income   ____________________________
Other Income   _______________________________

Source of Income   ________________________
Source of Income   ___________________________

_______________________________________________________________________

ASSETS

Funds on deposit (savings, checking,money market) $ ___________________________(E)

_______________________________________________________________________

LIABILITIES

Creditor Account Number Payment Balance

Mortgages: ________________ ________________ ______ ______________

Auto: ________________ ________________ ______ ______________

St. Loan: ________________ ________________ ______ ______________

Installments: ________________ ________________ ______ ______________

________________ ________________ ______ ______________

Revolving: ________________ ________________ ______ ______________

Other: ________________ ________________ ______ ______________

**Additional assets and liabilities (including alimony or child support) should be listed on a seperate sheet of paper and included with this sheet.

AUTHORIZATION TO RELEASE INFORMATION SHEET

I/We are requesting that Robar General Funding completes a pre-qualification to determine if I/we qualify for a loan. I/we authorize the recipient of this authorization to release any and all information pertaining to my credit history, income, bank, money market and similar account balances to Robert General Funding for the above stated purpose. A copy of this authorization may be as an orginal.

________________________________________________ ________________________________________________

Borrower's Signature Date Co-Borrower's Signature Date


ASSETS

Funds on deposit (savings, checking,money market)	$ ___________________________(E)
_______________________________________________________________________



LIABILITIES

	Creditor	Account Number	Payment	Balance
Mortgages:	________________	________________	______	______________
Auto:	________________	________________	______	______________
St. Loan:	________________	________________	______	______________
Installments:	________________	________________	______	______________
	________________	________________	______	______________
Revolving:	________________	________________	______	______________
Other:	________________	________________	______	______________
**Additional assets and liabilities (including alimony or child support) should be listed on a seperate sheet of paper and included with this sheet.


AUTHORIZATION TO RELEASE INFORMATION SHEET
I/We are requesting that Robar General Funding completes a pre-qualification to determine if I/we qualify for a loan. I/we authorize the recipient of this authorization to release any and all information pertaining to my credit history, income, bank, money market and similar account balances to Robert General Funding for the above stated purpose. A copy of this authorization may be as an orginal.