Maximum Monthly House Payment (if known) $

Total Long Term Monthly Debt: $
(Include long-term credit payments such as credit cards whose balances are carried for longer than 6 months, car loans, furniture loans, student loans, and other credit carried for more than 6 months.)

Credit Scores:
Good (>680)    Medium (620-680)     Low (<620)

Name:

Phone #

Address:

City: State: Zip Code:

Email Address:

Are you working with a Realtor? Yes   No

If yes, name of Realtor: