CLIENT APPLICATION FORM

Please complete in full our client application form.
We strongly recommend that you call to confirm the on-line application was received in our office.

BUILDER INFORMATION

New Home Builder

Date

Community

Prepared By

Builder Agent

Days Off

Phone Number

Cell Number

Has Contract Been Signed? Yes No

Agent Email Address

APPLICANT INFORMATION

Individual #1

Name

Home Phone

Business Phone

Fax

Cell Phone

E-mail Address

Individual #2

Name

Home Phone

Business Phone

Fax

Cell Phone

E-mail Address

EXISTING HOME INFORMATION

Street Address

City ZIP

County Subdivision

Lot Number

Directions to Home

Builder

# of Years in Home

Garage

Age of Home # of Bedrooms # of Baths

Homeowners Association

Foundation Type: Slab Crawl Basement Other

Pets? No Yes If Yes, List Type of Pets and Number

Pets

Water: City Water Well Water

Flood Plain: No Yes Flood Plain Insurance: No Yes

Sewer: City Sewer Septic System

Estimated Current Value of Your Home

First Mortgage Lender

Account #

Original Loan Amount

Current Balance

Type of Loan: Conventional Insured Conventional FHA VA

Other

Second Mortgage Lender

Account #

Original Loan Amount

Current Balance

Type of Loan: Conventional Insured Conventional FHA VA

Other

Is Your Home Currently on the Market?

By Owner: Yes No

By REALTOR®: Yes No

Listing Company

Listing Agent

Last List Price

List Date

Expiration Date

Are You Represented By a REALTOR®: Yes No

Listing Company

Stage of Construction

Listing Agent

New Home Sale Price

Lot #

Anticipated Closing Date

New Home Address

City ZIP