OFFICIAL PURCHASE/REFINANCE QUOTE FORM

Please complete the following information as completely and accurately as possible

General Information

Required Fields*  Valid Characters A-Z a-z 0-9 . , @ # _

Will there be a Co-Applicant? *    YES     NO
Is this a Purchase or Refinance?*    Purchase     Refinance

Borrower Information
Primary Applicant First Name: *
Primary Applicant Last Name: *
Applicants SSN #: Optional xxxxxxxxx
Street Address: *
City: *
State: *
Zip Code: *
How many years at current Residence *
Own the home? Yes No Live Rent Free
Home Phone: * xxxxxxxxxx
Cell Phone:
Work Phone:   Ext:
Current Email Address: *
How would you rate your Credit? *
Approx. Total Monthly Debt: * $ ex.500.00
Have you filed Bankruptcy in the last 7 Yrs? * Yes No
Have you had a Foreclosure in the last 7 Yrs? * Yes No
Do you pay child support or alimony?* Yes No
Name of Current Employer:
Gross Monthly Income: * $ ex.5,000.00
Years with Current Employer: *
Are you self Employed?: Yes      No

Co-Borrower Information
Co-Borrower's First Name:
Co-Borrower  Last Name:
Co-Borrower SSN #: Optional xxxxxxxxx
Street Address:
City:
State: 
Zip Code:
How many years at current Residence:
Own the home? Yes No Live Rent Free
Home Phone:  xxxxxxxxxx
Cell Phone:
Work Phone:   Ext:
Current Email Address:
How would you rate your Credit?
Have you filed Bankruptcy in the last 7 Yrs? Yes No
Have you had a Foreclosure in the last 7 Yrs? Yes No
Do you pay child support or alimony? Yes No
Name of Current Employer:
Gross Monthly Income: $ ex.5,000.00
Years with Current Employer:
Are you self Employed?: Yes      No

Purchase Information

Are you working with a Realtor?

Yes     No

If Yes, what is the Realtors Name?

Do you a home picked out?

 Yes    No

What County will the Property be located?

Property Type? *

Property Use? *

Estimated purchase price? *

 $

Desired new loan amount? *

 $
Contact Information
Best Time To Contact You:

Special Notes:
Limit 150 Characters

Thank You for Allowing our Loan Specialist to Assist You.

By submitting this form with your telephone number you are consenting for FHAInfo.com, any of its affiliates, providers, business partners or authorized representatives to contact you even if your name is on the Federal "Do not call List" to discuss the information in your request.