Please complete all fields. Use either "0" or "NA" if any question does not pertain to you. Thank you.

Contact Information

Name  
Address  
City  
State  
Zip Code Example 99999
Length of Time At This Address YEARS     MONTHS  
Home Phone Example 999-999-9999
Work Phone Example 999-999-9999
Cell Phone Example 999-999-9999
E-mail  

Financial Questions

Buying/Renting  
Monthly Mortgage / Rent Payment Example 1200 or 0
Current Employer YEARS     MONTHS  
Gross Monthly Income Example 10000
Pay Frequency  
Maximum Down Payment  
Maximum Monthly Payment  
When would you like to take possession? MM/DD/YYYY
Price Range  
Best Time To Contact You  
Credit Rating  
Comments
Example Credit Disclosure / Explanation, Special Requirements
Where did you hear about us?  

Privacy Notice

DISCLOSURE OF NON-PUBLIC PERSONAL INFORMATION

We are required by Federal law to inform you that our company gathers and stores nonpublic personal and financial information of potential, current and former consumers and customers.

This information is used in order to serve you in an efficient and timely manner.

At times, we disclose your nonpublic personal information with affiliates and nonaffiliated third parties as necessary to effect, administer or enforce our transactions with you. We may also share all of this information with companies such as financial lending institutions, credit bureaus and non-financial institutions.

These companies will be required contractually to keep your information confidential. Information collected may include:

  • Information obtained from you on applications or other forms such as your name, address, social security number, assets and income.
  • Information from affiliated companies such as payment history and other transactions.
  • Information from consumer reporting agencies including your credit history and other credit worthiness information.
  • Information from other third parties to whom you have given consent.

To ensure limited access to your nonpublic information within our company we have physical, electronic and procedural safeguards in place. These include:

  • Limited access to information storage areas
  • Electronic password and security codes required to access computer information.
  • Contractual requirements for third parties to comply with privacy laws.
  • Your personal information will not be sold, nor disclosed without your express permission.


   
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