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First Name
Last Name
Phone Number
Email Address
What is the preferred mode of contact?
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Phone
Email
What is the preferred time of contact?
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Morning (8am-12pm)
Afternoon (12pm-5pm)
Evening (5pm-8pm)
Do you have a down payment?
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No
How much? Enter the amount
Have you had a bankruptcy, short sale or foreclosure in the past three years?
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No
How will the property be used?
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Primary
Second Home
Investment
Have you had any mortgage late payments in the last three years?
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Yes
No
Estimated Credit Score
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580-669 ( FAIR )
670-739 ( GOOD )
740-799 ( VERY GOOD )
800-850 ( EXCEPTIONAL )
What do you plan to spend on your new home?
Do you currently own a home?
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Yes
No
What will you do with your current home?
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Rent
Sell
Retain
Zip Code
Type of Home
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Single Family
Condo
Manufactured Home
Current Monthly Income
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