Real Estate Intake Form

1

Have you owned a home in the past 3 years?If not, you're considered a first-time homebuyer! If so, you still may qualify.

YESNO

2

Have you signed any paperwork with a Real Estate Agent?

YESNO

3

Where would you like your new home to be located in?Please enter a ZIP CODE

4

Do you currently rent or own your home?

Rent

Own

5

Are you a Veteran or Active Duty Military?

YESNO

8

What is your desired Monthly PaymentEnter a monthly payment, including taxes and insurance, that feels comfortable in your budget. An estimate is fine.

9

Have you filed Bankruptcy in the past 7 years or had a Foreclosure or Short Sale in the past 2 years?

YESNO

10

What is your estimate household monthly income?This is your gross income before taxes.

under $5,000

$5,000 - $7,500

$7,501 - $10,000

over $10,000

12

Do you or a co-borrower work in any of the following professions?

Law Enforcement

Educator

Health Care Worker

Fire Fighter

13

If you qualify and could find the perfect home, how soon would you like to make a move?

ASAP

1-3 Months

3-6 Months

6+ Months

14

What is your email address?

example@example.com

15

What is your name?

First Name

Last Name

16

Where can we text your confidential results?Please enter a phone number that can receive text messages/

Area Code

Phone Number