PRINT FORM EMAIL FORM Application for Home Purchase Date____/_____/_______Where did you hear of us? __________________ Name:___________________________Phone Number:____-_____-______ Email:_____________________@_________________________________ Present Address:________________________________Apt. #___________ City:_____________________State:________Zip Code:________________ How Long have you been there?______yrs._______mths. Current monthly house payments $_____________ Current employer:_______________________Phone #_____-_____-______ How Long have you worked there?____yrs.____mths. □full time □part time Gross monthly income $_____________Other income $________________ Do you have: □checking account □savings account Do you require down payment assistance? □yes Do you require closing cost assistance? □no □other(401k, etc…) □own □rent □yes □no Do you currently monitor your credit? □yes □no My Credit is: □Good □o.k. □Bad PRINT FORM EMAIL FORM PAGE 2 Have you ever been evicted? □yes □no Claimed bankruptcy? □yes □no Have you ever been arrested for a violent crime? □yes □no Birth Date:_____/______/________ Social security # ___ ___ ___-___ ___-___ ___ ___ ___ Will there be a co-applicant? □yes □no -- If YES here, please fill in below-- If NO here, please go to last page-Name: __________________________ Phone Number:____-_____-______ Email:_____________________@_________________________________ Present Address:________________________________Apt. #___________ City:_____________________State:________Zip Code:________________ How Long have you been there?______yrs._______mths. Current monthly house payments $_____________ Current employer:_______________________Phone #_____-_____-______ How Long have you worked there?____yrs.____mths. □full time □part time Gross monthly income $_____________Other income $________________ Do you have: □checking account □savings account Do you require down payment assistance? □yes Do you require closing cost assistance? □no □other(401k, etc…) □own □rent □yes □no Do you currently monitor your credit? □yes □no My Credit is: □Good □o.k. □Bad PRINT FORM EMAIL FORM PAGE 3 Have you ever been evicted? □yes □no Claimed bankruptcy? □yes □no Have you ever been arrested for a violent crime? □yes □no Birth Date:_____/______/________ Social security # ___ ___ ___-___ ___-___ ___ ___ ___ _______________________________________________ Go to last page (PAGE4) PRINT FORM EMAIL FORM PAGE 4 Verification; Authorization; Confidentiality; Privacy; Disclosure I believe the statements I have made are true and correct. I, the undersigned, authorize Mile High Home Solutions, LLC to perform a credit check and/or a criminal check, verification of information I have provided and communication with any and all names listed on this application. X:______________________________Co-applicant:_____________________________ Date:_______/________/__________ Date:______/_______/__________ Mile High Home Solutions, LLC hereby maintains that all information given is for the purpose of processing this application and that all information gathered will remain confidential and will not be released to any other party, unless legally mandated to do so. Mile High Home Solutions, LLC also maintains that the managers of said entity are both active Licensed Colorado Real Estate Brokers. X: Date:________________________ For fastest service, you may return this application by fax or email. Email: Contact@mhHomeSolutions.net FAX: 720.887.4124 Mail to: MHHS -- 5023 West 120 Avenue #265 -- Broomfield, CO 80020 th EMAIL FORM