* First Name

* Last Name

* Email

Phone

Preferred  Method of Contact (Select Preference):

Email    Phone

Home Purchase Loan Survey

Have You Already Found a Home?

Yes    No

Estimated Purchase Date

Within 30 Days 31-60 Days 60-90 Days 90-120 Days Undecided

Purchase Price Range

$10,000 Below $10,001 - $20,000 $20,001 - $30,000 $30,001 - $40,000 $40,001 - $50,000 $50,001 - $100,000 $100,001 - $150,000 $150,001 - $200,000 $200,001 - $250,000 $250,001 - $300,000 $300,001 - $350,000 $350,001 - $400,000 $400,001 - $450,000 $450,001 - $500,000 $500,001 - $550,000 $550,001 - $600,000 $600,001 - $650,000 $650,001 - $700,000 $700,001 - $750,000 $750,001 - $800,000 $800,001 - $850,000 $850,001 - $900,000 $900,001 - $950,000 $950,001 - $1,000,000 $1,000,001 - $1,250,000 $1,250,001 - $1,500,000 $1,500,001 - $1,750,000 $1,750,001 - $2,000,000 $2,000,001 - $2,250,000 $2,250,001 - $2,500,000 $2,500,001 - $2,750,000 $2,750,001 - $3,000,000 $3,000,001 - $3,250,000 $3,250,001 - $3,500,000 $3,500,001 - $3,750,000 $3,750,001 - $4,000,000 $4,000,001 - $4,250,000 $4,250,001 - $4,500,000 $4,500,001 - $4,750,000 $4,750,001 - $5,000,000 $5,000,001 - $5,250,000 $5,250,001 - $5,500,000 $5,500,001 - $5,750,000 $5,750,001 - $6,000,000 $6,000,001 - $6,250,000 $6,250,001 - $6,500,000 $6,500,001 - $6,750,000 $6,750,001 - $7,000,000 $7,000,001 - $7,250,000 $7,250,001 - $7,500,000 $7,500,001 - $7,750,000 $7,750,001 - $8,000,000 $8,000,001 - $8,250,000 $8,250,001 - $8,500,000 $8,500,001 - $8,750,000 $8,750,001 - $9,000,000 $9,000,001 - $9,250,000 $9,250,001 - $9,500,000 $9,500,001 - $9,750,000 $9,750,001 - $10,000,000 $10,000,000 Up

Desired Mortgage Monthly Payment-Including Taxes

$1,000 Below $1,001 - $1,100 $1,101 - $1,200 $1,201 - $1,300 $1,301 - $1,400 $1,401 - $1,500 $1,501 - $1,600 $1,601 - $1,700 $1,701 - $1,800 $1,801 - $1,900 $1,901 - $2,000 $2,001 - $2,100 $2,101 - $2,200 $2,201 - $2,300 $2,301 - $2,400 $2,401 - $2,500 $2,501 - $2,600 $2,601 - $2,700 $2,701 - $2,800 $2,801 - $2,900 $2,901 - $3,000 $3,001 - $3,100 $3,101 - $3,200 $3,201 - $3,300 $3,301 - $3,400 $3,401 - $3,500 $3,501 - $3,600 $3,601 - $3,700 $3,701 - $3,800 $3,801 - $3,900 $3,901 - $4,000 $4,001 - $4,100 $4,101 - $4,200 $4,201 - $4,300 $4,301 - $4,400 $4,401 - $4,500 $4,501 - $4,600 $4,601 - $4,700 $4,701 - $4,800 $4,801 - $4,900 $4,901 - $5,000 $5,001 - $5,100 $5,101 - $5,200 $5,201 - $5,300 $5,301 - $5,400 $5,401 - $5,500 $5,501 - $5,600 $5,601 - $5,700 $5,701 - $5,800 $5,801 - $5,900 $5,901 - $6,000 $6,001 - $6,100 $6,101 - $6,200 $6,201 - $6,300 $6,301 - $6,400 $6,401 - $6,500 $6,501 - $6,600 $6,601 - $6,700 $6,701 - $6,800 $6,801 - $6,900 $6,901 - $7,000 $7,001 - $7,100 $7,101 - $7,200 $7,201 - $7,300 $7,301 - $7,400 $7,401 - $7,500 $7,501 - $7,600 $7,601 - $7,700 $7,701 - $7,800 $7,801 - $7,900 $7,901 - $8,000 $8,001 - $8,100 $8,101 - $8,200 $8,201 - $8,300 $8,301 - $8,400 $8,401 - $8,500 $8,501 - $8,600 $8,601 - $8,700 $8,701 - $8,800 $8,801 - $8,900 $8,901 - $9,000 $9,001 - $9,100 $9,101 - $9,200 $9,201 - $9,300 $9,301 - $9,400 $9,401 - $9,500 $9,501 - $9,600 $9,601 - $9,700 $9,701 - $9,800 $9,801 - $9,900 $9,901 - $10,000 $10,000 Up

Type of Property

Primary Single Family Home Primary Condo Home Second Home Investment Property Foreclosure Manufactured Home

Desired Type of Loan

Home Purchase Custom Construction Loan Home Equity Refinancing Senior Reverse Mortgage

Gross Annual Household Income

$30K or Less 30-45K 45-60K 60-75K 75-90K 90-105K 105-120K Over 120K

Your Credit Score

Excellent (740+) Good (700-740) Fair (650-699) Needs Improvement (600-641) Poor (499-599) Don’t Know

Desired Mortgage Term

30 Year Fixed 15 Year Fixed Construction Loan Other

Down Payment

Zero Down 1-3% 3-5% 5-7% 7-10% 15-20% Over 20%