Personal Email Address
# of Years
Previous Address (if at current address less than 2 years)
OwnRentLive with Family
Landlord Name/Mortgage Company
Rate of Pay
Can you be contacted at work?
Work Email Address
Previous Employer (if at current employer less than 2 years)
Other Income (2nd Job, Child Support, Social Security, Pension)
Amount per Month $
Stock/Bonds/Mutual funds $
Personal Email Address
Please provide a list of all accounts that you are currently paying. Please include car loans, credit and charge cards, personal loans, student loans, mortgage payments, bankruptcy or tax payments, child support and alimony.
I acknowledge that the above listed accounts are a full disclosure of the monthly bills that I am currently paying. I understand that without full disclosure the C4D Crew cannot make a correct determination of my approval status.
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If you are currently renting a property, when does your lease end?
What are your monthly rent payments?
Have you paid your rent/mortgage on time for the last 12 months?
Do you have any student loans?
If YES: Are they currentlybeing paiddefaulteddeferment
If BEING PAID: How much monthly $
If BEING PAID: Balance Remaining $
Are you obligated to pay child support?
If Yes: How much monthly $
Are the payments at the agreed amount and on time?
Have you ever filed for bankruptcy?
If yes: Was it Chapter 7 (liquidation) or Chapter 13 (repayment)?
Chapter 7Chapter 13
Has it been discharged?
If yes, When was it discharged?
Was it dismissed or cancelled?
Are you currently participating in a debt management program?
If YES: Please provide the name of the company
If YES: Please provide your monthly payment $
How would you refinance your loan from us?
What is your refinance timeframe?
Do you have any outstanding judgements?
Do you have any tax liens?
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Are you working with a real estate agent?
If YES: Please Provide Realtors Name & Phone Number Below
How did you hear about us?
List the areas of town where you are interested in living.
How much do you have for a down payment amount?
Please state what amount of house payment would be most comfortable for your budget.
How long have you been trying to purchase a home?
Why have you not been able to purchase a home?
Have you attempted to purchase a home or apply for a mortgage in the past year?
If YES: What were the results?
Please provide any information or comments that you would like to have considered.