Personal Contact Information

Please fill out the following form.

Fields with a * are required.

PRIMARY APPLICANT
Name: (First and Last) *
Email*
Phone Number*
Cell
Street Address
City
Postal Code

SECONDARY APPLICANT If no scondary applicant please put n/a in each box
Name: (First and Last) *
Email*
Phone Number*
Cell

EMPLOYMENT HISTORY
Occupation and Employer
Supervisor's Name
Work Number
Years worked
If less than 3 years Previous Employer
Previous Employer Contact Information
What is your yearly income?

MONTHLY EXPENDITURES
What are your monthly combined expenses, excluding housing?
How much do you have for a downpayment?
What do you think a manageable monthly house payment would be?

DESIRED HOME
Please describe what type of residence you want. Single home, Townhouse, Condo, Acreage, etc.
Number of bedrooms
Number of bathrooms
Desired possession date

CREDIT SCORE AND DEBT
Current Credit Score. If you do not know, read the credit score page first. (It will open in another window)
Do you have any outstanding bad debt?	Yes No
Do you have any accounts in collections?	Yes No
Enter the details of you debt amounts.
How did you hear about us?	Used Victoria Craigs List Kijiji Billboard Internet Personal Referral Used Cowichan Word of Mouth Newspaper