Your First & Last Name

Email Address

Phone Number

Spouse Information

Home Purchase or Refinance? Home Purchase or Refinance? Purchase Refinance

Primary Residence or Secondary Home? Primary Residence or Secondary Home? Primary Secondary

When Do You Plan To Buy a New Home? When Do You Plan To Buy a New Home? Already under contract Immediately - I'm making a offer I'm shopping and considering a few options Within a couple of months Not sure - I want to know what I can afford

In What City Will The Property Be Located? (List City Name & State)

Are You Currently Working With A Real Estate Agent? Are You Currently Working With A Real Estate Agent? Yes No

Estimated Purchase Price?

How Much Are You Putting For A Down Payment?

Is This Your First Time Buying A Home? Is This Your First Time Buying A Home? Yes No

Will You Have A Co-Borrower? Will You Have A Co-Borrower? Yes No

What Is Your Annual Income?

Are You Currently Employed? Are You Currently Employed? Full Time Part Time Self-Employed No, I am not employed

Estimate Your Current Credit Score Estimate Your Current Credit Score Excellent 720+ Good 680-719 Fair 640-679 Poor 639-

When Were You Born?

Have You Or Your Spouse Ever Served In The Military? Have You Or Your Spouse Ever Served In The Military? Yes No

Have You Had A Bankruptcy or Foreclosure In The Past 7 Years? Have You Had A Bankruptcy or Foreclosure In The Past 7 Years? Yes No

How Long Ago Was The Bankruptcy?

How Long Ago Was The Foreclosure?

What Is Your Street Address?

How did you hear about us? How did you hear about us? Facebook Family/Friend referral Realtor referral Other