Homebuyer Assistance Intake Form
Let’s begin your home-buying journey! Fill out this form to help me learn more about how I can help you.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Is it okay to contact you by phone to follow up with you ?
*
Yes
No
If so, what's a good time to contact you during the week?
Eastern Standard Time Hour Eastern Standard Time Minutes
AM
PM
AM/PM Option
What state do you currently live in?
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
What is your total monthly income (before taxes)?
*
Which of the following are your sources of income? (Select all that apply)
*
Employment
Self-Employment
SSI (Supplemental Security Income)
SSD (Social Security Disability)
Child Support
No Income
Other
How long have you worked at your current job?
*
Please Select
Unemployed
Less than 6 months
6 months to 1 year
1-2 years
2-5 years
More than 5 years
Have you ever experienced a foreclosure?
*
Yes
No
How much is your current monthly rent?
*
Do you currently have a car loan?
*
Yes
No
What is your estimated credit score?
*
Please Select
Below 550
550-599
600-649
650-699
700-749
750 or above
Not sure
Do you plan to apply for a mortgage or buy cash?
Mortgage
Buy cash
Is there anyone going on the mortgage with you and what is their income?
Do you have your last two W-2 forms available?
*
Yes
No
Do you have a preference for where you'd like to buy ?
*
What challenges do you think you specifically need help with to prepare for home buying?
Is there anything else you'd like for me to know?
Submit
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