First Name
*
Last Name
*
Home Address
*
City
*
State
*
Zipcode
*
Home Phone #
*
Work Phone #
Monthly Income Before Tax
Social Security Number
Have you been in your job two years
*
Yes
No
How much is your monthly debts
Where do you want a house
How many bed rooms do you want
How many square feet
Do you want a Detached house
Yes
No
Do you want a town house/ condo
Yes
No
Do you have a good credit
*
Yes
No
Maximum mortgage payment
Maximum cost of house
How soon do you want to move
*
What date do you want to meet with me
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How much can you put down
*
Do you want down payment assisant
Yes
No
Are you a first time home buyer
*
Yes
No
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