PRE-QUALIFY

YOU:						SIGNIFICANT OTHER:
First Name:		MI:		Last Name:		First Name:		MI:		Last Name:

Email Address:

Home Phone:

Work Phone: Ext.

Cell Phone:

Best to contact You:
You will be contacted personally to go over mortgage options, so please indicate what means to best contact you.
Home Phone Work Phone Cell Phone EMail   Anytime Daytime Evenings

Current Street Address:

City:

State:

Zip:

Are You Self-Employed: No    Yes    If Yes, How Long?:  less than 1 year 1 - 2 yrs 2 - 5 yrs 5 - 10 yrs 10+ yrs

Type of Home:
Condo  Townhome  Loft  Single Family Residence  Duplex  Not Listed 

Additional Information or Questions:

OTHER PREFERENCES:

Would you like to be on our email distribution list? We periodically send emails to our customers that contain news and information about the real estate market.
No   Yes

If you are already working with one of our Mortgage Consultants, please tell us which one so we can direct your query to the right person immediately.
Jeff Watson Brian Dover Paul DeBlasis Greg Parnell Ken Rainey Jared Tawzer Jim Anglin Julie Pendergrass Kevin Allen Leslie Benish