Intake Questionnaire Form

1

Full Name

First Name

Middle Initial

Last Name

2

Phone Number

3

E-mail

example@example.com

4

HOW MUCH HAVE YOU SAVED FOR A DOWN PAYMENT & CLOSING?

$5000 - $10,000

$10,000 - $15,000

$15,000 +

HAVEN'T STARTED YET

6

DO YOU HAVE ANY STUDENT LOANS?

YES, I AM CURRENTLY PAYING & UP TO DATE

YES, THEY ARE CURRENTLY IN DEFERMENT

YES, HOWEVER THEY ARE CURRENTLY IN DELINQUENCY

NO, I DO NOT HAVE ANY STUDENT LOANS

7

WHAT TYPE OF INCOME DO YOU RECEIVE?

I AM 1099, SELF-EMPLOYED

I AM A W2 EMPLOYEE

I RECEIVE SOCIAL SECURITY/DISABILITY

OTHER

8

DO YOU HAVE AT LEAST 2-YEARS OF EMPLOYMENT HISTORY?

YES, I HAVE AT LEAST TWO YEARS AS A 1099/W2 EMPLOYEE

NO, I DO NOT HAVE AT LEAST A TWO-YEAR EMPLOYMENT HISTORY