Home interested in     Date

E-mail Address       

Applicant Name         SSN  Birth Date

Co- Applicant Name   SSN  Birth Date  

Current Address          City, State, Zip         

Phone                        Best time to call

Co-Applicant

Has any of the above employment been through a temporary service and if so which one(s)?

Do you pay child support?          yes   no  

Amount per month   

County paid to   

Do You receive child support ?   yes   no 

Amount per month   

County received from  

How much additional income do you receive from other sources per month ?

Source of additional income?

Current monthly rent amount?   Paid by:   cash  check  money order

Do you have receipts or canceled checks for the last 12 months yes   no

How long have you rented here ?  

Have you paid your rent on time in the last 12 months? yes   no

Have you filed your taxes the last 2 years yes   no

Have you owned a home in the last 3 years ?    yes   no

If needed, do you have a co-signer available ?   yes   no           Who ? 

Number of children living with you ?  

What is the maximum total monthly house payment you feel you can afford ?  $

If any, what type of construction/remodeling skills do you have? 

how would you rate these skills (average, good, excellent...etc.)?   

Would you be willing to do work on a home as a down payment?    yes    no

Are you currently in a Foreclosure or Bankruptcy?    yes    no

How would you rate your credit payment history the last 12 months ? good   fair  poor

Have you written any non-sufficient funds checks in last 2 months ?  yes   no

Have you had any payments 30 days late in the last 12 months ?   yes   no

Do you have a good payment history with your car insurance and utilities ?  yes   no

Is it OK to pull credit  for Applicant and Co-Applicant ?   yes   no

Briefly explain any credit issues such as Bankruptcy, Foreclosure, Repossessions, Collections, Judgments or Late payments. Please include approximate dates.

 Monthly bills other than rent, utilities, cable, phone, food and clothing. Things such as car payments, rent-a-center payments, furniture payments, etc. 

Type                                                 Monthly Payment                Months left on loan

Total of funds you have available for down payment and closing cost ? $0 to $1,000 $1,001 to $2,000 $2,001 to $3,000 $3,001 to $4,000 $4,001 to $5,000 $5,001 to $6,000 $6,001 to $7,000 $7,001 to $8,000 $8,001 to $9,000 $9,001 to $10,000 $10,001 to $15,000 $15,001 to $20,000 $20,001 to $25,000 $25,001 to $30,000 $30,001 to $40,000 $40,001 to $50,000 $50,001 and up  

Source of those funds

How much do you have in your 401k ?   

How much is available through a gift from family or friends ?  

How much and when will you be receiving any additional funds, such as tax refund, work bonus or inheritance ?

Do you own a credit card ?  yes   no

List type and value of any large items owned such as cars, boats, jet ski, 4 wheeler, wide screen TV, motorcycle, antiques, snow mobiles, etc.

Any additional information you would like us to know?