| Your First and
Last Name: |
|
| Current Address: |
|
| City, State: |
|
| Zip Code: |
(i.e. 99999) |
| Home Phone: |
(i.e. 999-999-9999) |
| Work Phone: |
(i.e. 999-999-9999 or NA) |
| Cell phone,
Pager or Message #: |
(i.e. 999-999-9999) |
| Buying or Renting |
|
| Monthly Mortgage
or Rent Payment |
(Enter numbers i.e. 10000 or 0) |
|
Years/Months at Current Address: |
(e.g. 3 / 1.5) |
|
Years/Months at Current Employer: |
(e.g. 3 / 1.5) |
| Gross monthly income: |
(Enter numbers i.e. 100000) |
| Pay
Frequency: |
|
| Maximum down payment: |
(Enter numbers i.e. 10000 or 0) |
| Maximum monthly
car payment: |
(Enter numbers, e.g. 1000 or 0) |
|
When would you like to take possession: |
(Enter future date, MM/DD/YYYY) |
| Price Range: |
|
| Best time to contact you: |
|
| Email address: |
|
| Current Credit Rating: |
Excellent
Good
Fair
Poor
|
Comments, Concerns
or Conditions:
|
(e.g. Credit disclosure/explanation, special requirements) |
| Where did you hear about us: |
|
