Comprehensive Housing Affordability and Income Verification Form

Comprehensive Housing Affordability and Income Verification Form
This form helps us collect your personal information and check your credit score, which is like a report card for how you handle money. This check starts the process of figuring out how much you can afford to pay each month for a house, whether you want to rent it or buy it. We'll look at each house you're interested in one by one to give you a special report that fits just you.

We use your credit score to see if you can get help with a home loan and how much money you can spend on housing every month. We look at how much you owe compared to how much money you make every month. This helps us decide the highest amount you can pay for housing each month. We do this by first checking your debts and your income, which tells us how much you can safely spend on where you live without spending too much.
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Martial Status

MarriedSingleEngagedSeparationWidowedOther
Do you anticipate changes to this in the next 12 months?

YesNoN/AOther
Elaborate
Are utilities currently in your name?

YesNoN/AOther
Will you rely on anothers income / assets and/or credit for qualification?

YesNoOther
This source relationship to you:
Name of Support
Will this support come from an occupant in the home?

YesNoN/AOther
Will this support come from a co-owner?

YesNoN/AOther
Will you be relying on funds for deposit / downpayment / initial costs beyond your earnings / investments to qualify?

YesNoOther
Select source of funds beyond your own savings/ investment:

GiftN/AGrantOther
Elaborate ( If Grant, Name Contact of Grant Program)
Are you obligated on any alimony?

Yes, court orderedYesNoN/AOther
Are you current on your payments?

YesNoN/AOther
How much pay and what frequency , other terms?
Are you obligated on any child support?

Yes, court orderedYesNoN/AOther
Are you current on your payments?

YesNoN/AOther
How much pay and what frequency, other terms?
Until what Date?

MonthDayYear
Date
Are you a US citizen?

YesNoOther
Are you a permanent green card holder?

YesNoN/AOther
Do you have an ITIN #?

YesNoN/AOther
What total housing payment limit would you like to set for your search?
When will you have 6x that payment limit saved or in retirement account?

Have it nowWithin 30 daysWithin 60 daysWithin 90 daysOther
Will you be sharing responsibility for the monthly payment?

YesNoOther
This source relationship to you:
Name of Source
Will this support come from an occupant in the home?

YesNoN/AOther
Will this support come from a co-owner?

YesNoN/AOther
Do you have a 401K?

YesNoOther
Select all that you have:

Money Market AccountStock / Bond PortfolioPensionRetirement AccountSelf Directed IRARoth IRAN/AOther
Total Market Value in Accounts Above - if you’d like list for each with custodian name and amount
Have you ever had a mortgage loan on a primary residence in the last 3 years?

YesNoOther
Life Insurance

Yes Full LifeNoneOther
Do you have any real estate titled in your name [not a primary residence] anywhere in the USA?

YesNoOther
list real estate owned: investment or second home ? Address, Annual Property Taxes, Annual Home Owners Insurance, Liens Y/N Amount Owed Approx, Payment Includes taxes insurance, is there an association fee, flood insurance fire insurance? current occupied , current rent received monthly includes utiltiies? purchased titled to you when date? approx value?
Do you lease any vehicles?

YesNoOther
How many?
In your name on your credit report?

YesNoN/AOther
Do you own / finance any vehicles?

YesNoOther
How many?
In your name on your credit report?

YesNoN/AOther
Make, Model, Year , Value of any Vehicles You OWN / FINANCE - your name , or name of a business
Title to:

My nameMy name / and anotherBusiness Name OnlyOther
Name as it appears on your Drivers License
Name as it appears on your Tax Return
Name as it appears on your Social Security Card
Social Security Number
Date of Birth

MonthDayYear
Where do you reside?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
When did you relocate to this residence?

MonthDayYear
Prior to this residence, where did you reside?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Prior Residence : Move In Date

MonthDayYear
Date
Prior Residence : Move Out Date

MonthDayYear
Date
Rent Own

RentOwnLiving with FamilyOther
Was there an agreement in place where you by name were responsible for the monthly payment obligations?

YesNo
How did you contribute?

CashCheckOther
From what account ( Bank Name - Checking or Savings )?
Was it the same day range every month?

YesNo
What amount?
Was this the amount that will show on the statement?

YesVariesOther
Why?
Move in Date

MonthDayYear
Move out Date

MonthDayYear
Where do you reside?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Address on your tax return

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Address on your drivers license

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Address on your Pay

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Veteran Status

ReservesRegular100% disabled to war time dutyN/AUsed VA benefits in the past to own a homeOther
Ethnicity:

Hispanic or LatinoNot Hispanic or Latino
Additional Nationalities:
Male Female Other

MaleFemaleOther
Income types:

Temporary DisabilityPermanent Disability for selfPermanent Disability for othersSocial SecurityPensionRetirement AnnuityTrustRental IncomeOther Types of Fixed IncomeDividends from InvestmentsOther
Are you currently earning as a 1099 independent contractor?

NoYesOther
Earning in the name of :

Sole Proprietor / My Own NameIn the Name of my BusinessN/AOther
Business(s) Name
Registered Business Address:
Formation Type

Sole ProrpietorLLCS CorpN/AOther
Ownership?

Sole Member OwnerPublicly TradedPrivately HeldN/AOther
Describe the Nature of Your Business
Count of all employees including yourself
Date Formed

MonthDayYear
Date
Federal EIN number
Business Vehicles?

YesNoN/AOther
What is your % equity ownership of the business?
What % of Voting Shares do you hold?
Are you currently W2 employed?

YesNo
How many W2 employers do you currently have?
Do you have a familial relationship to ownership of any of these employers?

YesNoN/AOther
NAME OF EMPLOYER
START DATE

MonthDayYear
Date
Currently Employed here?

YesNoOther
END DATE

MonthDayYear
POSITION / TITLE
LINE OF WORK
YEARS IN LINE OF WORK
Do you own a percent of the business?

YesNoN/AOther
What percent ownership?
Compensation Hourly or Salary?

HourlySalaryN/AOther
What is your salary (before taxes and deductions)?
What is your rate of hourly pay?
Full time (40+ hrs) or Part Time?

Full time (40+ hrs)Part TimeOther
Do you expect this to change within the next 12 months?

YesNoN/AOther
Please explain:
When was the last pay raise you received?

MonthDayYear
What was the change?
Do you anticipate another payraise in the next 12 months?

YesNoN/AOther
Do you know what your new rate of pay will be at that time?

YesNo
When do you expect another payraise?

MonthDayYear
What will be your pay rate at that time?
How frequently are you paid?

WeeklyDailyBi Weekly1st & 15thMonthlyOther
Do you work overtime?

YesNoN/AOther
How Frequently do you work Overtime?

NeverRarelySometimesOftenOther
Do you get a premium for your pay ( like time and a half ) for overtime?

YesNoN/AOther
What is your pay rate for the overtime?
Do you receive any of commission or bonus?

YesNoN/AOther
What is the terms and frequency of these additional forms of compensation?
Is the amount consistent?

YesNo, it variesN/AOther
When is this paid out?
When did you begin receiving this additional pay?

MonthDayYear
When was the last time you received this form of additional pay?

MonthDayYear
How Many W2s will you earn at the end of this year?
How Many W2s did you earn for last years work?
How Many W2s did you earn for the year prior to last years work?
How are you paid?

CashCheckDirect DepositN/AOther
Where does this money go (Bank Name , Account Type , Last 4 of Acct Number) or other.
For your cover of total amount in reserve cash to invest in a home (could do not necessarily would do, also supports evidence of reserves after collecting keys - shows strength in application) - List your bank name and any others on that account - the current balance - type : ie checking or savings - last 4 digits of account number
All of it?

YesNoN/AOther
Have you had a short sale in the last 7 years?

YesNoOther
Have you had a sheriff sale in the last 7 years?

YesNoOther
Have you had a foreclosure in the last 7 years?

YesNoOther
Have you had a bankruptcy in the last 7 years?

YesNoOther
Currently convicted of Fraud?

YesNo
Plead guilty to Fraud?

YesNo
Are you currently a co-signer to help another qualify for a loan?

YesNoN/AOther
What is the debt you have cosigned for another?

Student LoanCar PaymentMortgageN/AOther
Total Count of Credit Lines you co-sign for another.
Who makes the payments?

I doThey doN/AOther
Your relationship to the primary creditor
Do you intend to occupy this as your primary residence (more than 6+ months a year)?

YesNoOther
Are you personally contractually obligated to a house payment?

YesNoOther
Type of Obligation:

RentOwnN/AOther
When does your lease expire?

Month to MonthN/AOther
Do you share the obligation?

YesNoN/AOther
What is your relationship to the others sharing the obligation?
What is your PORTION OF RESPONSIBILITY to the monthly obligation in $/ or % of the housing payment obligation?
What % does this represent of the total contract amount?
What is that total contract amount for the housing payment?
Select if it includes?

InsuranceTaxesAssociation FeesWater UtilitiesGas UtilitiesElectric UtilitiesSewerTrashCable TVWifiOther
Is your house payment current?

YesNoN/AOther
Please verify that you are human*
Should be Empty: