Buyer Intake Form
Turning Dreams Into Addresses
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
Birthdate
Will you be adding a co-borrower?
Please Select
Yes
No
If yes, what is their credit score?
Co-borrower’s Name
First Name
Last Name
Co-Borrwer’s Email
example@example.com
Co-borrower’s phone number
Format: (000) 000-0000.
How soon are you looking to purchase?
Tell Me About Your Home
Indicate Price Range
$-$$$ USD
Have you been employed for a minimum of 2 years?
Please Select
Yes
No
Are you W2 or Self Employed?
Please Select
W2
Self Employed
I claim from both
Do you have access to 401K or a savings account? How much money do you have liquid for your home purchase?
What is your current credit score across all 3 bureaus? Please check MyFico.com if you are unsure.
Have you filed for Bankruptcy (Chapter 7 or 13) in the last seven years? If yes, when was it discharged?
Have you been approved by a lender?
Please Select
Yes
No
If Yes Specify Lender Name and Please submit pre-approval
Are you currently working with another agent?
Please Select
Yes
No
Preferred style of home
Single occupancy house
Apartment/Loft
Flat
Ranch Style
Bungalow
Split Level
Duplex
Number of Bedrooms
Number of Bathrooms
Square Feet
Enter a range (ex: 1000-2000)
Acres
Enter a range (ex: 1000-2000)
Amenities
Central Air Conditioning
Appliances
All Electric
Sky Lights
Other
Specify additional amenities
Additional Information
Submit
Should be Empty: