Reverse Pre-Qual

Please complete the form below and expect a completed analysis from Plaza Reverse!

* Indicates required field.
Loan Originator:*
NMLS ID: *
Minimum four characters
Company Name:*
Account Type:*
Company ID:*
E-Mail:*
Phone:*
ext
Borrower Married?: *
Borrower First Name:*
Borrower Last Name:*
Borrower Birth Date:*
   Format: mm/dd/yyyy
Co-Borrower First Name:
Co-Borrower Last Name:
Co-Borrower Birth Date:
   Format: mm/dd/yyyy
Total Monthly Household Income:*
If not known, enter zero
Total Household Assets:*
If not known, enter zero
Total Monthly Housing Expenses:*
(Taxes, Insurance, HOA, etc.)
If not known, enter zero
Number of Household Members
Living in Subject Property:*
If not known, enter zero
Estimated Property Square Footage:*
If not known, enter zero
Monthly Credit Debt:*
(Minimum payments from credit & installment)
If not known, enter zero
Credit Evaluation (Pick all that apply): *
Address of Subject Property:*
City of Subject Property:*
State of Subject Property:*
Zip Code of Subject Property:*
County of Subject Property:*
Market Value of Home:*
Balance Due on 1st Mtg:*
Balance Due on 2nd Mtg:*
Other Liens, if so how much?
Type of Home: *
Transaction: Is this for a purchase?*
Do you plan to use a Power of Attorney (POA) in this transaction?*
Is this loan Vested in a Trust?*
Is this a refinance of an existing reverse mortgage?*
Is this loan being transferred from another reverse lender?*
Plaza Home Mortgage   
Account Executive: *
Any additional comments: