Personal Information

* Name
Street Address
City
State
Zip Code
* Phone Number
* Email Address
FAX Number
* Required information marked with an asterisk.

---

Do you have a lot location where the home is to be delivered?

City
State
County

---

Expected Date of Completion?

Date

---

Home Style Desired

Desired Style of Home              - select - Ranch Hi-Ranch Cape Chalet Split Level Colonial Two Story Victorian Other (Please specify)

Square Footage or Dimensions

---

Home Specifications

Number of Bedrooms    - select - Three Bedrooms Two Bedrooms Four Bedrooms

Number of Bathrooms   - select - Two Bathroom One Bathroom Three Bathroom Four Bathroom

Garage Size                    - select - Two Stall Garage Three Stall Garage Four Stall Garage Oversize Garage

Basement                       - select - Full Basement Partial Basement Crawl Space Slab

Additional Specifications (Be as specific as you wish)

---

Mortgage Details

Package Desired                           - select - Complete Home, Ready to Move In Buy Wholesale w/ Site Work Sub-Contracted

Home Price Range                        - select - $50,000 to $60,000 $60,000 to $70,000 $70,000 to $80,000 $80,000 to $90,000 $90,000 to $100,000 $100,000 to $120,000 $120,000 to $140,000 $140,000 to $160,000 $160,000 to $180,000 $180,000 to $200,000 Over $200,000

Land Price Range                          - select - Under $5000 $5000 to $10,000 $10,000 to $15,000 $15,000 to $20,000 Over $20,000

Complete Package Price Range   - select - $50,000 to $60,000 $60,000 to $70,000 $70,000 to $80,000 $80,000 to $90,000 $90,000 to $100,000 $100,000 to $120,000 $120,000 to $140,000 $140,000 to $160,000 $160,000 to $180,000 $180,000 to $200,000 Over $200,000

---

Additional Information

Do you already own your building lot?           - select - Yes No

Size of property you would like to purchase   - select - Single Lot Double Lot One Acre Five Acres Ten Acres Over Ten Acres

Financing Details                                             - select - Pre-Arranged In Need of Financing Cash Buyer

Cash Available for Down Payment                 - select - Under $5000 $5000 to $7500 $7500 to $10,000 $10,000 to $12,500 $12,500 to $15,000 $15,000 to $17,500 $17,500 to $20,000 $20,000 to $25,000 $25,000 to $30,000 Over $30,000

Gross Annual Income                                      - select - Under $30,000 $30,000 to $40,000 $40,000 to $50,000 $50,000 to $60,000 $60,000 to $70,000 $70,000 to $80,000 $80,000 to $90,000 $90,000 to $100,000 $100,000 to $120,000 $120,000 to $140,000 $140,000 to $160,000 $160,000 to $180,000 $180,000 to $200,000 Over $200,000

Credit Status                                                    - select - Excellent Very Good Good Some Late Pays Bankruptcy in Past Poor

Is there anything else I need to know to help you obtain a mortgage?