Integrity Home Buying, LLC

BUYER PROGRAM REQUEST
SUBMISSION FORM

Serving Buyers of Homes Across America

Please fill out this form as the first step to begin your process to a new home. This is NOT the Pre-Qualification and no credit check will be done at this stage. It is only letting us know of your interest, ability to meet the down payment requirements, and the basics of what you are looking for. Once we agree to work together, a simple one page Pre-Qualification will be done that will need your signature for the credit report. Please do not submit this if you are currently in Bankruptcy or you do not have at least 12 months of Rent or Mortgage payment history. Do not submit this if you or your Spouse/Co-borrower have had a foreclosure in the last 3 years. We can work with just about everything else to get you into a nice home if you have 5 to 10 % cash down payment. For example, charge-offs, late pays, past bankruptcies, late bills and more. You must have steady employment for the last 12 months. Upon receiving this we will be in touch with you about getting the Pre-Qualification, discussing your home preferences, and answering any questions have.

(*) Indicates a required field, but the more information you can fill in, the more we are able to guide you into the home of your choice quickly and smoothly.

First Name*

Last Name*

Mailing Address*

City*

State*

Zip*

Daytime Telephone*

Evening Telephone*

Fax

Email*

Years at Current Address*

Years/Months on Current Job*

Are You Self Employed*

Yes No

Gross Income From Any Sources*
("Gross" means before taxes)

Years/Months on Current Job for Spouse or Co-borrower

Is Spouse or Co-Borrower Self Employed?

Yes No

Gross income from any sources of Spouse or Co-Borrower

What area must you live in*

Do you have a home selected

Yes No

If yes, what price:

Will you occupy this home*

Yes No

If yes, when do you need to move by*

Maximum Monthly Payment you believe you can make including everything*

Maximum Down Payment you have saved*

(Other acceptable sources can be: Relatives/Employer loan; 401K plan at work; credit cards; selling an asset such as one car; borrowing from Whole Life Insurance)

Home bedrooms desired

Please check all those that apply for you:

Other Comments:

NOTE: If you experience difficulties submitting this form, please print a copy of it and fax it to
804-741-6313 or mail it to:

Integrity Home Buying, LLC
P.O. Box 3986
Glen Allen, VA 23058

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