USDA Pre-Qual Questionnaire 

Applicant 1:

Are You A

Source of Income - How much in the following: (Monthly Income)

Applicant 2:

Are You A

Source of Income - How much in the following: (Monthly Income)

Other Household Members

Applicant 1: 

Applicant 2: 

Debts: (car payments, credit cards, etc.)

If they work, attach check stubs and tax returns for household member(s) over 18

Adjusted Gross Income on Tax Returns for:

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