1st Buyers Information:

1st Buyer's Name:   ^*       

Home Phone Number: Mobile Phone Number:

Fax Number:         e-mail Address:

Age:   Date of Birth:  ^*        Marital Status:  Married   Single Separated ^*        Number of Dependents: Ages:

Present Address: ^*    City: ^*  State:^*    Zip Code: ^*

Own/Rent?^*  Own   Rent   How Long:  ^*  Monthly Payment:  ^*

Name of Employer:     Employer's Address:

Type of Business:     Work Phone:

Title/Position: Years on Job:                 Self Employed?  No: ; Yes:

We can work with all credit issues:  How is your credit?  Good   Fair   Poor   Not Sure

2nd Buyer's Name:  

Home Phone Number: Mobile Phone Number:

Fax Number:     e-mail Address:

Age:   Date of Birth:        Marital Status:  Married   Single Separated         Number of Dependents: Ages:

Present Address:     City: State:     Zip Code:

Own/Rent?  Own   Rent      How Long: Monthly Payment:

Name of Employer:     Employer's Address:

 Type of Business:     Work Phone:    

Title/Position: Years on Job:                 Self Employed?  No: ; Yes:

We can work with all credit issues:  How is your credit?  Good   Fair   Poor   Not Sure

        ********************************************************

Total Gross Monthly Work Income of all Buyers:  ^*    Other Monthly Income:

Please Describe Other Income (Ie. Rent/ Child Support, Etc.):

Total ALL Monthly Expenses (Current Rent/Mortgage, Food, Clothing, Car, Credit Cards, Utilities, + etc...):  ^*

Monthly Mortgage Payment you are comfortable with:  ^*        If you s-t-r-e-t-c-h-e-d, you could/would pay:  ^*

Total Down Payment or Closing Costs (if any) available NOW for your new home?  ^*

If you s-t-r-e-t-c-h-e-d, you could/would pay:  ^*

        ********************************************************

1st Choice area of your new home:  ^*    2nd Choice:

Minimum Number of Bedrooms:  ^*    Minimum Number of Bathrooms:  ^*

Other Specific Needs (Example: Handicapped accessible):

Questions/Comments:

ACKNOWLEDGMENT AND AGREEMENT: THIS IS NOT AN APPLICATION FOR CREDIT OR A MORTGAGE LOAN. I/We certify that the above information is correct as of the date set forth. I understand that any intentional or negligent misrepresentations of this information may result in civil liability and /or criminal penalties. This submitted form  is also acceptable for any legal purpose.  I/We understand that you must run our credit report.   I/We understand Owner is not a mortgage broker however, Owner may or may not submit this and other documents to a licensed mortgage company that offers B/C credit lending.  If I/We cannot qualify, then Owner may finance at his sole discretion. Verification or re-verification of any information contained in this document may be made at any time by any potential lender, its agents, successors and assigns, either directly or through a credit-reporting agency.