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32
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1
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2
Full Legal Name
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First Name
Last Name
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3
DOB
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Date
Month
Day
Year
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4
Phone Number
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Please enter a valid phone number.
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5
Current Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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6
Email Address
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example@example.com
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7
SSN (last 4 only)
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8
Preferred Method of Contact
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Email
Phone Call
Text Message
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9
Marital Status
*
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Single
Married
Domestic Partnership
Other
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10
Household & Applicant Details
*
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Number of applicants
List all applicants
Are all applicants earning income?
No If no, list non‑earning applicants:
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11
Current Housing Status
*
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Renting
Living with Family/ Friends
Transitional Housing
Hotel /Short- Term Stay
Homeless or At-Risk
Other
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12
Monthly Rent Payment
if not applicable put N/A
Payment Amount
Length of Time at Current Residence:
Landlord Contact (optional)
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13
Employment Information
if not applicable put N/A
Employer Name:
Job Title:
Start Date:
Gross Income
Other Source of Income
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14
Income / Employment Status Information
Full Time
Part Time
Hourly
Salary
Self Employed
Fixed Monthly Income
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15
Budget & Expenses
Monthly Income (Household Total)
Monthly Expenses (Household Total)
Checking Balance
Savings Balance
Do you have a written budget?
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16
Have you reviewed your credit report within 90 days?
*
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YES
NO
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17
Major Debts
check all that apply
Auto Loan
Student Loans
Credit Cards
Collections
Personal Loans
Medical Bills
Collections
Charge- Offs
Repossessions
Child Support
Late Payments (past 12-24 months)
None
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18
Total Monthly Debt Payment
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19
Have you ever file for Bankruptcy?
*
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YES
NO
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20
If yes , what was the discharge year?
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21
Savings & Assets
Amount saved for home purchase?
Do you expect to receive gifts?
Do you have retirement or investment accounts?
Are you eligible for down payment assistance ? ( if unsure we will evaluate)
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22
Target Move-in Timeline
*
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Please Select
0-3 months
3-6 months
6-12 months
12 + months
Please Select
Please Select
0-3 months
3-6 months
6-12 months
12 + months
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23
Homebuyer Goals
*
This field is required.
Purchase Price Range
Preferred Locations
Please Select
House
Condo
Townhouse
Multi-Family
Please Select
Please Select
House
Condo
Townhouse
Multi-Family
Property Type
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24
Briefly Describe Your Housing Goals?
*
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25
Document Checklist (Required to Start)
Government-issued ID Most recent 30 days of pay stubs Last 2 months of bank statements Most recent 2 years of W‑2s Self-employment P&L or 1099s Proof of additional income (child support, SSI, etc.) Credit Report (client provided) Budget Worksheet 60 days bank statements Retirement/401k statements Gift letter (if applicable) Credit report authorization Child support documentation Bankruptcy discharge papers Student loan details
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26
Please upload any supporting documents (e.g., pre-approval letter, property photos, ID, etc.)
*
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Drag and drop files here
Select files to upload
Max. file size
: 10.0MB
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27
Homebuyer Consulting Service Menu
*
This field is required.
PACKAGE 1 — Document & Readiness Prep - $199 (Primary Applicant) / additional applicant ($99)-This package focuses on getting clients financially organized and ready for the early stages of the homebuying process.
PACKAGE 2 — Homebuyer Navigation Program - (4 - 6 week process) - $299 (Primary Applicant) / additional applicant ($149) - This package offers deeper coaching, more guidance, and structured weekly support.
PACKAGE 3 — Full Journey Concierge - (90 day process) - $499 - $699 (Primary Applicant) / additional applicant ($199) -This is your premium full-support package with long-term guidance and high-contact communication.
PACKAGE 4 - Homeownership Cost Review - $149 (standard package) - This package is designed to help homeowners understand and manage ongoing ownership costs.
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28
Referral Preferences
check all that apply
Mortgage Lender
Realtor
Down Payment Assistance Programs
Credit Counselor
Tax Preparer
Contractor / Repair Services
Insurance Provider
Other
None
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29
I certify that all information provided is true and complete to the best of my knowledge. I authorize Fleming Unlimited Solutions, LLC to provide consulting services based on the information above.
*
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30
Service Authorization
*
This field is required.
I authorize Fleming Unlimited Solutions to provide consulting, evaluation, and referral services needed to help me prepare for and navigate the homebuying process.
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31
Document Release Authorization
*
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I authorize Fleming Unlimited Solutions to: Receive documents from me Share required documents only with approved lenders or service providers that I consent to
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32
Credit Review Authorization (optional)
*
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I authorize Fleming Unlimited Solutions to review a copy of my credit report or credit information for consultation purposes only.
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33
By signing, you hereby acknowledge and agree to proceed with the selected services and affirm your acceptance of all applicable terms and conditions as presented.
*
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