Home Buyer Interest Form Buyer Information First Name: Last Name: Address: City: State/Prov: AlabamaAlaskaAlbertaAmerican SamoaArizonaArkansasBritish ColumbiaCaliforniaColoradoConnecticutDelawareDist of ColumbiaFed. St. of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundlandNorth CarolinaNorth DakotaNorthern Mariana IslandsNorthwest TerritoryNova ScotiaNunavutOhioOklahomaOntarioOregonPennsylvaniaPrince Edward IslandPuerto RicoQuebecRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingYukon Territory Zip/Postal Code: Home Phone: Work Phone: Mobile Phone: Receive SMS Notifications: E-mail Address: Are you looking to purchase: In the next 30 days30-90 daysWhenever I spot a good enough deal Property Type Single Family,Mobile W/ land HomeMulti Family HomeTownhouseCondominiumManufactured Home Rent/Own RentOwn Pre-Approved? YesNo I would like a 1st/2nd option regarding rates and terms for a mortgage: YesNo City of Interest #1: City of Interest #2: City of Interest #3: City of Interest #4: City of Interest #5: City of Interest #6: City of Interest #7: City of Interest #8: City of Interest #9: City of Interest #10: State/Prov of Interest: AlabamaAlaskaAlbertaAmerican SamoaArizonaArkansasBritish ColumbiaCaliforniaColoradoConnecticutDelawareDist of ColumbiaFed. St. of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineManitobaMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew BrunswickNew HampshireNew JerseyNew MexicoNew YorkNewfoundlandNorth CarolinaNorth DakotaNorthern Mariana IslandsNorthwest TerritoryNova ScotiaNunavutOhioOklahomaOntarioOregonPennsylvaniaPrince Edward IslandPuerto RicoQuebecRhode IslandSaskatchewanSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingYukon Territory Min. # of Bedrooms: Min. # of Bathrooms: Price Range: Minimum Maximum Monthly Payment: Down Payment: The ideal home for me would be (describe): Promo Code: Are you interested in: Buying for yourselfLease Option or Land ContractBuying an investment property to rent outBuying an investment property to rehabInterested in rentingCommercial Financing (A current credit report may or may not be obtained) (We will use this information to qualify you for a loan through a traditional lender or through our owner financing program) Social Security Number: Date Of Birth: Date Of Employment: Job Title: Employer Name: Date Of Residence: Gross Monthly Income: Monthly Rent/Mortgage: Housing Status: RentOwn Checking Account: YesNo Savings Account: YesNo Marital Status: SingleMarried