Online Application

It's nice to know where you stand . . . before you make the decision to buy a home. The purpose of this form is to provide information that will assist us in estimating your borrowing potential. Most lenders call it "pre-qualifying."

Note: We respect our clients' privacy. The information you provide below is for MJM use only and is strictly confidential. We never sell or give away information our clients provide unless they specifically request that we do so in writing.

Please provide the following contact information:

First Name

Last Name

Middle Initial

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Work Phone

Home Phone

FAX

E-mail

How many people reside in your household?

What is your Gross Monthly Income (before taxes)?

What is your total monthly debt payments (including child support)?

What is your monthly rent payment?

How long have you rented (years/months)?

How long have you been with your current employer (years/months)?

Do you have a house in mind?

Yes
No

If so, what is the purchase price of the house?

Please rate your credit:

Good
Poor
No Established Credit

If you have a co-applicant, what is his/her name?

First Name

Last Name

Middle Initial

What's the best time to contact you?

-- hh:mm am/pm

Would you like to be contacted for permission to run a credit report?

Yes, please contact me by phone.
Yes, please contact me by e-mail.
Not yet, I still have some questions.

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Send mail to jdduvall@charter.net with questions or comments about this web site. Last modified: 07/21/07

Send mail to jdduvall@charter.net with questions or comments about this web site.
Last modified: 07/21/07