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Name *

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Last

Email *

Phone *

I need help finding *A Mortgage Specialist A Real Estate AgentBoth

Timeframe to purchase? *1-3 months3-6 months6 months and beyond

Do you currently own or rent?OwnRent

What is your current monthly housing payment?

How long have you been with your current employer?

What is your gross monthly family income?

Can you document your income with W-2's and/or tax returns for the past 2 years?YesNo

What are your total monthly debt payments? (car loans, student loan, credit cards, child support…)

How would you rate your credit score? *Perfect >750Excellent 700-749Very Good 650-699Good 600-649Needs Work 560-599

Are there any lates on the credit report in the last 12 months *YesNo

Have you ever filed Bankruptcy *YesNo

What Type?Chapter 7Chapter 13

Date Bankruptcy was filed?

Date Bankruptcy was discharged?

Approximate cost of new home? *

How much money do you have to use for the down payment and closing costs? *

In What State are you looking to purchase a home? *AKALARASAZCACOCTDCDEFLGAGUHIIAIDILINKSKYLAMAMDMEMIMNMOMPMSMTNCNDNENHNJNMNVNYOHOKORPAPRRISCSDTNTXUMUTVAVIVTWAWIWVWY

What City would you like your new home to be located *

Best time to contact you

Is the file still in dispute *

• Yes
• No

Dispute completion date

CIG contact *

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