Purchase Mortgage Information Form

Please fill out the following questions and submit

Tell Us About Yourself:

First Name

Middle Initial

Last Name

Email Address

Current Address

Preferred Phone Number

Are you a first time home buyer? Yes  No

What is your employment status? Full TimePart TimeSelf EmployedHomemakerStudentUnemployed

Are you or your spouse on active duty or a veteran of the U.S. military? Yes  No

Tell us about the Property:

Have you found a new home? Yes  No

What type of property are you looking for? Single Family DetachedTown HomeCondoManufactured Home

How will you use the property? Primary HomeSecond HomeInvestment

Estimated purchase price? $

How much do you have available for a down payment? Less than 5%5% to 10%11% to 15%16% to 20%More than 20%

What state will the new property be located in?

Tell us about your finances:

How would you describe your credit? ExcellentGoodFairPoor

If you've ever declared Bankruptcy, when was it discharged? Never DeclaredNot yet discharged1-12 months ago13-24 months ago25-36 months ago37-48 months ago49-60 months ago61-72 months agoover 72 months ago

Do you have any forclosures? Never ForeclosedIn Foreclosure1-12 months ago13-24 months ago25-36 months ago37-48 months ago49-60 months ago61-72 months agoover 72 months ago

If you currently own a home, what is your current monthly housing payment? $

Will you continue to make this payment after you purchase the new home? Yes  No

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Click here to submit. You will be contacted shortly.