| Applicant Information |
| First Name: |
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| Last Name: |
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| Marital Status: |
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| Spouse's Name (If Applicable): |
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| Address Street 1: |
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| Address Street 2: |
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| City: |
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| Zip Code: |
(5 digits) |
| State: |
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| Address Information |
| Present Address: |
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| How long have you been at this address: |
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| Reason for moving: |
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| Monthly payment: |
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| Landlord's name and number: |
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| Previous Address: |
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| How long were you at this address: |
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| Reason for moving: |
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| Monthly payment: |
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| Landlord's name and number: |
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| Contact Information |
| Home Phone: |
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| Cell Phone: |
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| Work phone: |
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| E-mail Address: |
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| Best time to reach you: |
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| Employment Information |
| Present employer: |
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| How long with this employer: |
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| Occupation: |
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| Gross monthly income: |
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| Supervisor: |
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| Phone number: |
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| Previous employer: |
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| How long with this employer: |
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| Occupation: |
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| Gross monthly income: |
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| Supervisor: |
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| Phone number: |
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| Financial Information |
| Approximate balance in checking: |
(USD) |
| Approximate balance in savings: |
(USD) |
| Do you have a 401k or retirement plan: |
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| Total monthly installment loan payments (car loan, credit cards): |
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| Other Information / Miscellaneous Information |
| Have you ever filed for bankruptcy: |
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| If so, when: |
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| Have you ever been evicted: |
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| If so, when: |
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| Have you ever been convicted of a crime (if so, please describe in the "Comments" section): |
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| Do you have any pets (if so, how many, what type, breed and weight in the "Comments" section): |
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| What are you looking for? |
| Address of property you're interested in: |
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| Bedrooms: |
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| Bathrooms: |
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| Basement: |
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| Garage: |
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| Fenced in Yard: |
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| Area or School District: |
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| Apply for our "Sweat Equity Program" |
| Are you willing to clean: |
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| Can you paint: |
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| Would you rather do the work and reduce your cost: |
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| Are you in the trades: |
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| What other work are you qualified to do: |
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I authorize Margret-Ann Miller's House of Real Estate to verify
the above information. |
