Congratulations!

You could be one of the select number of individuals/families who benefit from the
Steven Blackwood Stimulus Savings.

Please take a few moments to provide the following information and I will immediately process a pre-qualification for you.

This pre-qualification does not obligate you to make a home purchase.


Borrower Information:
 
Borrower First Name:
Borrower Last Name:
Borrower Middle Initial:
Cell Phone#:
Work Phone #:
Home Phone #:
E-mail Address
Present Address:
Address (cont'd):
City:
State/Province:
Zip Code/Postal Code:
  
Years at Present Address:

  
 
Previous Address:
Address (cont'd)
City:
State/Province:
Zip Code/Postal Code:
Years at Previous Address:
  
Employer:
Occupation:
   (Position & Title)
Employers Address:
# of years:
Gross Income
(Before Taxes Taken Out):
Social Security Number
Date of Birth: (ex. dd/mm/yyyy)
Co-Borrower Information:
 
Co-Borrower First Name:
Co-Borrower Last Name:
Co-Borrower Middle Initial:
Date of Birth: (ex. dd/mm/yyyy)
Cell Phone #:
Home Phone #:
Work Phone #:
  
Employer:
Occupation:
   (Position & Title)
Employer Address:
# of years:
Gross Income
(Before Taxes Taken Out)::
Soc. Security #:
 
Gross Annual Income:
 

Do either of you have income 
from any other source?

 Yes     No
If so, from whom? 
Amount? 
Do either of you receive Child Support?Yes    No 
If so, how much? 
Do either of you pay Child Support?Yes     No 
If so, how much? 
   

Credit Card:


Amount Owned:
Monthly Payment:

Credit Card:
Amount Owned:
Monthly Payment:

Credit Card:
Amount Owned:
Monthly Payment:

Credit Card:
Amount Owned:
Monthly Payment:

Debt:
Amount Owned:
Monthly Payment:

Debt:
Amount Owned:
Monthly Payment:

Debt:
Amount Owned:
Monthly Payment:
    
Credit Rating:                          Good  Fair  Poor
Funds Available For Closing Costs:                           
 
Do you currently own a home?                                       Yes  No
Do you rent?Yes   No  
If so, how much is your monthly rent? 
How do you pay?
Are your rental payments always on time?Yes   No
Have you ever filed for bankruptcy?Yes   No
If so, what chapter?
When did you file? 
(ex. dd/mm/yyyy)
When was it discharged? 
(ex. dd/mm/yyyy)
Where?
What lead you to our quick & easy application process? 

Friend-Referral Newspaper Blackwood Team Professional Homes & Land Magazine
Premier Homes Magazine Online Sign In Yard Billboard Other

Please indicate who referred you to our on-line application. If you are already working with one of our Blackwood Team Professionals, please provide their name:
 A referral is the greatest compliment we can receive.  If someone recommended us to you, please tell us who.
 
 

 Agency Representation Disclosure
Agency Representation & Blanket Authorization By Submission I hereby understand that the Blackwood Team and/or their Agents represent the Seller(s) of real Property in which buyer(s) may consider for purchase.  By submitting this information, I hereby authorize the Blackwood Team, their affiliates, assigns and/or any credit reporting bureau which it may designate; permission to obtain any and all information concerning my/our employment, checking and/or savings accounts, obligations, and all other credit matters, including a credit report. This information is to be used in an effort to secure financing options for a home and/or property purchase. I hereby acknowledge that I/we are not working with any other Realtor.  My/our desire is to work with an agent of the Blackwood Team. This authorization includes, but is not limited to information contained in my request for a loan, past and/or present employment history, past and/or present income records, credit explanation, bank account(s), stock holding, assets and /or liability balances, past and/or present landlord references consumer credit references, etc. I understand that under Right to Financial Privacy Act of 1978, 12 U.S.C. 3401, et seq., the Blackwood Team shall be authorized to access my/our Financial records held by any and all finanicial institutions in connection with the consideration or adminstration of assistance to me/us. I further understand that the entire record involving my/our loan and loan application will be available to authorization shall be accepted as valid as an original document of authorization shall be accepted as valid as an original document of authorization. It shall be reproduced or photocopied and a facsimile or photocopy shall be accepted as valid as an original document of authorization.

I agree to the above:
I do not agree to the above		Yes   
No
    

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