(310) 640-0100
Please note that the fields marked with an asterisk (*) are required.
Contact Information
*Full Name:
*Email Address:
*Best Contact Number:
Your Home Purchase
What type of property are you buying?
What kind of occupancy is the property going to be used for?
What price range are you looking in?
What is your goal for a monthly mortgage payment, not including taxes or insurance?
What amount do you wish to put as a down payment?
Will you be getting a gift for any part of the down payment?

How much of a gift?
What is your desired loan type
Real Estate Agent You Are Working With:
Your Personal Information
OK to run credit:
Credit FICO score last time checked:
*Present Address:
Number of Years at Present Address:

( If less than 2 years provide previous address )
Previous Address:
Number of Years at Previous Address:
Currently, do you rent or own?

What is your monthly rent or mortgage (include monthly property taxes and insurance cost)?
Employment Information
Name of employer / company:
Years at Job:
Position/ Title/ Type of Business:
Financial Information
Are you self employed?

Do you have a corporation?

Do you pay yourself a base salary / W2?

How much is your base salary?
Any remainder income / earnings?
What is your average GROSS income the last 3 years?
Last Year:
2 Years Ago:
3 Years Ago:
What is your average NET income the last 3 years?
Last Year:
2 Years Ago:
3 Years Ago:
Year-To-Date Income:
Do You Receive A Base Salary Or Hourly Pay?
Base Salary:
Do You Receive A Bonus?

Pay Per Hour:
How Many Hours Worked Per Week:
Year to date:
Last year:
Year before:
Year to date:
Last year:
Year before:
Monthly Auto Payment:
Minimum Monthly Credit Card Payments:
Do you pay each month in full?

Monthly Student Loan Payment:
Alimony / Child Support Payment:
Other Installment Loan Payments:
Other Real Estate Loan Payments:
Checking/ Savings ( balance):
401k / IRA:
Stocks & Bonds (Outside 401k / IRA):
Do you own another property?

Do you have a co-borrower?