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Short Prequalification Form By completing the following questions about yourself we will be able to begin the prequalification process. Your answers will give us a better understanding of your needs and desires so that we can tailor make a loan just for you! Prequal Request Your Name: Email: Phone (H),(W): Zipcode Best time to reach me: Please contact me by: Phone E-mail Property Information Property Type: Owner Occupied Second Home Investment Non-Owner Occupied Property Location: Home Value: Loan Information Loan Type: Purchase Refinance - No Cash Out Refinance - Cash Out Home Equity Loan Amount: Monthly Gross Income: Monthly Debt*: *car payments, credit cards, alimony or child support etc... (not to include rent or mortgage payment) Once you have completed this expression of interest or application your information will be sent to First City Bancorp. A representative from First City Bancorp may contact you by telephone or email. By submitting your expression of interest you are consenting to receive telephone calls or email from First City Bancorp.

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