Information Request Form

 

Please use this form as your first means of contacting us with any questions about our programs, as the information you provide on the form will allow us to provide faster, more accurate guidance.

 

This is a secure form. This form requires NO compromising personal information, NO social security information, and we will NOT run a credit check. The form simply provides us with an overview of your scenario so we can best assist you as quickly as possible.

 

Please be as honest and accurate as possible so that we may best serve you. Please list any questions you have at the bottom of the form.

 

Please fill in all boxes - enter a "0" or "n/a" for the items that do not apply.

 

This information will be used only by us and will not be distributed in any way whatsoever.

 

Thank you for your interest in our program. Fields marked with an asterick (*) are required.

 

 

Your Contact Information
I am... (please select one) *
First Name *
Last Name *
Co-Borrower First Name
Co-Borrower Last Name
Your Street Address*
Your City*
Your State*
Your Zip Code*
Contact Name*
Daytime Phone *

*
*(NOTE: You must provide a phone number that we can reach you during
business hours of 9 am to 5 pm Eastern Time.)
Primary Email *
About Your Project

 

 
Project City*
Project State*
Project Zip*
Are Ready to Make an Offer?
Or Do You Already Own?*
Offer Price or
Current Loan Payoff*
Est. Cost to Renovate*
Est. Value After Renovation*
Down Payment*

 

About Your Financing Request
Your Gross Income (before taxes)*:
please list monthly gross income
Co-Borrower Income (bef. taxes):
please list monthly gross income
Other Monthly Income
please list all other income as monthly income
Borrower Income is...*
Co-Borrower Income is...
Monthly Car Payments: ($)
Monthly Credit Card Payments: ($)
Monthly Rent or Mortgage Pmt: ($)
Other Monthly Payments?: ($)
Alimony/Child Support Monthly: ($)
Amount in checking and savings accounts (liquid):($) *
401(k), IRA, retirement accounts: ($) *
Stocks/Bonds/Funds (liquid): ($) *
Your Estimated Credit Score:*
Co-Borrower Est. Credit Score:*
Have You Ever Filed Bankruptcy?*
Bankrupcty Type:
Have You Ever Had a Foreclosure or Short Sale?*
Have you had ANY other credit issues in the last 3 years, such as any late payments, tax liens, court judgments, etc?
Do you have any comments or questions?

 

Don't forget to claim your FREE $300 in Groceries from your favorite grocery store.

 

==> After submitting this form, you will receive a confirmation email to the email address you provided above within 120 seconds. You must click on the confirmation link to verify your request. You will then be taken to the download page for your Grocery Gift Certificate. We will not contact you unless you have verified your request by clicking on the verification link in the email.



 

Thank you for taking the time to submit the form. We will review it and get back to you within 48 hours. At that time, we can discuss some of your specific plans, questions and concerns. If you choose to go forward, we will send you a full application.