Loan Prequalification Form. Upon completion, the form will be emailed to Ms. Heather Mason and/or Mr. Scott Davis at Platinum Capital. You may also phone them with the information at 310-796-5600

There is no cost or obligation for pre-qualification.

Please fill out all fields in order for us to process your request.

Borrower___________________________Co-Borrower

Name -------------------------

Home Phone ------------------

Work Phone ------------------

Social Security Number -------

Address -----------------------

City ---------------------------

State --------------------------

Zip ----------------------------

Job Position/Title --------------

Years -------------------------

_____________________________________________________________

INCOME:

Gross Monthly Income --------

Bonuses/Commision -----------

Other --------------------------

Total ---------------------------

______________________________________________________________

BANK ACCOUNTS AND INVESTMENTS (Borrower and Co-Borrower Combined)

Checking

Savings

Stocks/Bonds

Equity of Present Home

Other

TOTAL

______________________________________________________________

DEBTS (Borrower and Co-Borrower Combined)

Charge Cards Monthly Payment Balance

Installment Loans: Monthly Payment Balance

Real Estate Loans Monthly Payment Balance

Alimony/Child Support/Separate Maintenance Monthly Payment

Authorization

Verification or reverification of any of the information herein, including a complete credit profile, may be made at any time by Platinum Capital Group its agents, successors, and assigns, either directly or through a credit reporting agency, from any source named herein, and the original copy of this form will be retained by Platinum Capital Group even if response to the prequalification is unfavorable.

By clicking the Submit Form button, I/We certify that the information contained herein is true and accurate to the best of our knowledge as of the date of the form submittal..