Informational Request Form The first step in taking advantage of the amazing program is to provide some basic information about yourself here. This informational request form will prepare us to discuss the program to meet your specific needs. This is not a financial form and your credit report will not be ordered. Our lenders cannot offer financing outside the U.S.A.

Fields marked in red are required. First Name: Last Name: Spouse's Name: Address 1: County: City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, DC West Virginia Wisconsin Wyoming Zip: Home Phone:   Use Format: xxx-xxx-xxxx Work Phone:   Use Format: xxx-xxx-xxxx Fax:   Use Format: xxx-xxx-xxxx Email:  Annual Household Income:  Referred by: (or name of rep)  Do you rent or own?   Rent Own  Monthly Rent or Mortgage:  If you own, what amount of equity do you have now:  Do you own land?   Yes No  If you do, is it paid for?   Yes No  If you do, what is the land's value?  What is your credit rating?   Please Select Excellent Good Fair  Have you had a bankruptcy?   Yes No  If yes, how long ago?  What kinds of work contribution would you bring to this project? (e.g. overseeing project, management skills, painting skills, carpentry skills etc.)  Best time to contact you:   Please Select Morning at home Morning at work Evening at home During the day at home During the day at work Other: specify in comments  OK to call you at work?   Yes No  When do you plan to build?   Please Select As soon as possible Within 3 months 3-6 months 6-12 months Not sure  Comments:

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