Primary Buyers First Name*

Primary Buyers Last Name* 

Co-Buyers First Name           

Co-Buyers Last Name            

Address*                                   

City*                                          

State*                                        

Zip Code*                                  

Phone*                                      

Fax                                          

Email*                                     

How did you hear about us?* Please Choose One Business Card Flyer Letter Newspaper Ad Post Card Post-it Note Referral Road Sign Sign on Car Val-Pak Other

What is the most you can raise for a down payment?* Please Choose One Less than a $1000 $1000 - $2000 $2000 - $3000 $3000 - $4000 $4000 - $5000 $5000 - $6000 $6000 - $7000 $7000 - $8000 $8000 - $9000 $9000 - $10000 $10000 - $15000 $15000 - $20000 $20000 - $25000 $25000 - $30000 More than $30000

Is your down payment available now?*

What is your ideal monthly payment?*

What is your household income before taxes?*

What is your current mortgage or rent payment?*

What are your monthly debts?*

How would you classify your credit?* Please Choose One Excellent Good Fair Ugly

How long have you been with your current
place of employment?* Please Choose One Less than 3 months 3 - 6 months 6 - 12 months 1 - 2 years 2 - 3 years 3 + years

What areas would you consider living in?*

Minimum # of bedrooms you require?*

Minimum # of bathrooms you require?*

How much square feet do you need?*

How much acreage do you need?* Please Choose One Does not matter Under 1/2 acre 1/2 - 1 acre 1 - 2 acres 2 - 3 acres 3 + acres

How soon can you move when we find
the home you want?*

Will you consider a home that needs work?*

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