How Did you Here About Us? Google WWW Search Craigslist Applicant Name Co-Applicant Name Funds available for purchase * Upload Bank Statement (optional) Source Of Funds Savings/Checking Account 401k Family Gift Other (please explain) Availability Of Funds Immediately 30 Days 60 Days 6 Months Other (Please Explain) When Are You Planning To Move? Where Are You Planning To Move? List Citys or Townships What Price Range Of Home Are You Planning To Buy? 0-25k 25-50k 50-75k 75-100k 100-125k 125-150k over 150k What Type Of Home (select all that apply) Bank Owned Private Owned HUD Home As Is Condition Completely Remodeled What is the maximum monthly payment amount you can afford? (including taxes and insurance) Current Address City State Zipcode Home Phone Cell Phone Email Address* Applicant DOB Applicant SSN Applicant Employer Annual Income Base Pay How Long Employed Applicant (brief job description) Co-Applicant DOB Co-Applicant SSN Co-Applicant Employer Annual Income Base Pay How Long Employed Co-Applicant (brief job description) Have you ever filed bankruptcy? Yes No If yes please explain what happened. Have you ever been involved in a property foreclosure? Yes No If yes please explain what happened. Auto Loan - Monthly Payment Balance (2nd) Auto Loan - Monthly Payment Balance Credit Card - Monthly Payment Balance (2nd) Credit Card - Monthly Payment Balance Child Support - Monthly Payment Balance Misc - Monthly Payment Balance Misc - Monthly Payment Balance Misc - Monthly Payment Balance If your were referred to us by a Real Estate Agent please provide there contact information below. Agent Name Agent Phone # Agent Office Please include in the comments section below the MLS # or the complete address of the property(s) you are interested in purchasing. If you would like us to perform a propety search for you please include the type of home, location, size, style and any other features that are important to you. Comments AUTHORIZATION TO DISCLOSE FINANCIAL INFORMATION - By submitting this form you acknowledge that you have read and accepted our disclosure regarding Agency Relationships. The information set forth herein may be disclosed to any person or institution involved with the sale/purchase of the premises. Furthermore, you authorize us to obtain your credit report(s) for analysis. Authorization To Disclose Financial Information * Yes No