Marketing Lead Form
Date: _______________ 1
st
Call Back Date: _________________ 2
nd
Call Back Date: _________________
Borrowers: ___________________________________________________________________________
Address: _____________________________________________________________________________
City: _________________________________________ State: _____________ Zip: _________________
Phone: ______________________ Cell: _____________________ Work: _________________________
Email: _______________________________________________________________________________
1
st
Mortgage Info – FHA/VA/CONV/ADJ – Other: _________________
Lender: ______________ Rate: _____________ Term: ___________ BK: 7/13 Discharge Date; ________
Payment: _____________Taxes: ______________ Insurance: _____________ HOA: _________________
Balance: ______________Property Value: _________________ Tax Repayment Plan: Y/N Loan Mod: Y/N 30-
day late payments past 12 months: Y/N Loan Mod: Y/N # of years: ______
Property Type: SFR – Townhome – Condo – MFG – Duplex – Other: __________
DO you own any other homes; Yes/No if so address: __________________________________________
2nd Info – Lender: ________ Payment: _________ Rate: ____ Balance: ___________ Stripped in BK: Y/N
Personal Info-
Borrower: _____________________________ Co- Borrower: ___________________________________
W2 Self-Emp 1099 Retired Military: Y/N W2 Self-Emp 1099 Retired Military: Y/N
SSN: ________________ DOB: ____________ SSN:__________________ DOB: ____________
Employer: ______________________________ Employer: ______________________________
Years Worked: ______________ FICO: ________ Years Worked: ___________ FICO: __________
Income: ________________________________ Income: ________________________________
Borrower Goals: _______________________________________________________________________
_____________________________________________________________________________________
Any other Debts or Notes: