Agent Assigned
Lender Assigned
Sent to Lead Manager
Date: _________________
Buyer Questionnaire Form
Name
Name
Address_____________________________
Address_________________________
___________________________________________
______________________________________
Home Phone
Home Phone
Work Phone
Work Phone
Cell Phone
Cell
Cell same as home
Yes
No
Cell same as home
Yes
No
E-Mail
E-Mail
Facebook____________________________
Facebook________________________
Date of Birth__________________________ Date of Birth______________________
SS#_________________________________ SS#____________________________
Employer____________________________
Employer________________________
Annual Income________________________ Annual Income____________________
Are you buying yourself or with someone else? __________________________________
Price Range_______________Monthly Pymt $___________________
# Bedrooms ____ # Baths _____ Basement _________ Garage ________ Fireplace _________
Any particular location? _________________________ Style?________________________
Desired Cities________________________________________________________________
Schools___________ _________
Tell me a little bit about your dream home?… _________________________________________
____________________________________________________________________________
____________________________________________________________________________
Will you be buying by yourself or with someone else?_________________________________
(add co-buyer’s information above)
Do you have a budget for monthly payments?
Yes
No
How much?______________
Will you be paying cash or will you be financing the home?
Cash
Financing
Have you been pre-approved by a lender?
Yes
NO
Who did you speak with? ____________________
When were you pre-qualified? ________________
If you are not working with a lender currently, our lender partner will pull your credit report and
will contact you to advise you on your purchasing power within the next business day. How
would you rate your credit?
Excellent
Good
Fair
Poor
Have you fled your taxes for the past two (2) years?
Yes
No
Can you provide us your bank statements for the past three (3) months?
Yes
No
Can you provide us your pay stubs from the past 30 days?
Yes
No
®
Are you working with a REALTOR
?
Yes
No
If so, How long? __________________ Have you signed an agreement?
Yes
No
Do you currently
Own or
Rent