PURCHASE REQUEST Where in Florida county is property located? Please hold down Ctrl button to make multiple selections! SELECT Pinellas Pasco Hernando Other Do you have a Sales Contract on a Property? NO YES What type of property are you looking to get a loan for? Please hold down Ctrl button to make multiple selections! SELECT Primary Residence Single Family Primary Condo Primary Townhome Primary Multipule Family Dwelling Second Home Condo Second Home Town Home Second Home Mobile Home Second/Vacation Mobile Home Primary Single Family Second Home Multi Family Dwelling Investment Condo Investment Mobile Home Investment Townhome Investment Multiple Family Dwelling How much are you looking to put down? What is the source of your down payment? SELECT Money in the bank Sale of exhisting home Gift No down payment Other What is the purchase price? i.e. $150,000 SELECT 0-3 Months 4-6 Months 7-9 Months 10-12 Months OVER 12 Months Please indicate estimated purchase date: What type of loan are you looking for? SELECT 30 Year Fixed 30 Year Adjustable 15 Year Fixed 15 Year Adjustable OTHER Do you currently own OTHER property? NO YES Are you a first home buyer? YES NO NO Are you currently working with a Realtor? YES Click in the box whether Annual 0r Monthly Income Annual Income Household Income (GROSS INCOME). Monthly Income Please select your Credit History as: SELECT Excellent Some Problems Major Problems Did you Foreclose or File for Bankruptcy in the last 7 years? SELECT NO Last Year 2 Years Ago 3 Years Ago 4 Years Ago 5 Years Ago 6 Years Ago 7 Years Ago FIRST NAME                                      LAST NAME YOUR NAME YOUR E-MAIL ADDRESS: YOUR ADDRESS: (include Street Address, City, State & Zip Code) How long have you been in your current job? SELECT Less than 6 mos. 6 to 12 mos. 1 to 2 years More than 2 years Retired Are you self-employed? NO YES Phone Numbers of Work and Home: (Include area code and extension, if applicable)