Soft Check Intake Form
Please fill out the form with accurate information.
Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Social Security Number
*
Current Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
When did you move in?
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Do you rent or own your house?
*
Rent
Own
Live Rent Free
Marital Status
*
Married
Unmarried
Separated
Are you planning to buy a home or refinance an existing loan?
*
Please Select
Buy a home
Refinance
Estimated Purchase Price
*
Estimated Value of Property
*
Down Payment
*
Current Mortgage Balance
*
Employment Status
*
Employed
Self-Employed
Retired
Unemployed
Other
Company/Employer Name
*
Annual Income (USD)
*
Position or Title:
*
Employment Start Date:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Employer Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
If less than 2 years, please list former employer. If more than 2 years, please list N/A.
Previous Employment Start Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Do you have a co-borrower?
*
Please Select
Yes
No
Full Name - Co-borrower
*
First Name
Last Name
Phone Number - Co-borrower
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email - Co-borrower
*
example@example.com
Date of Birth - Co-borrower
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Social Security Number - Co-borrower
*
Employment Status - Co-borrower
*
Employed
Self-Employed
Retired
Unemployed
Other
Company/Employer Name - Co-borrower
*
Annual Income (USD) - Co-borrower
*
Employment Start Date - Co-borrower:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Employer Address - Co-borrower:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
If less than 2 years, please list former employer. If more than 2 years, please list N/A.
Previous Employment Start Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
*
Submit
Submit
Should be Empty: