Islamic Home Financing: Pre-Qualification Form

Lessee Information
* First Name of Lessee :
*Last Name of Lessee :
* Email :
* Address :
* City :
* State :
* Zip Code :
* Home Phone :	xxx-xxx-xxxx
Cell Phone :	xxx-xxx-xxxx
Business Phone :	xxx-xxx-xxxx
DOB :	mm/dd/yyyy
Profession :
Marital Status :
Name of Employer :
Years at this employment :
* Monthly Income($) :
What is the credit rating of the Lessee? :
Co-Lessee Information (if applicable)
First Name of Co-Lessee :
Last Name of Co-Lessee :
Address :
City :
State :
Zip Code :
Home Phone :	xxx-xxx-xxxx
Cell Phone :	xxx-xxx-xxxx
Business Phone :	xxx-xxx-xxxx
DOB :	mm/dd/yyyy
Profession :
Marital Status :
Name of Employer :
Year at this employment :
Monthly Income($) :
What is the credit rating of the Co-Lessee? :
Please answer the following questions ?
Do you presently own or rent ?
Are you presently purchasing or refinancing ?
Value or Purchase Price($) :
What amount of on account payment can you make for the home?($) :
What is the total amount of monthly payment you make against your credit cards and loans ?($) :
Please answer the following questions ?
Have you ever filed Bankruptcy :	No Yes
If yes, what was the date of discharge? mm/dd/yyyy :
What Type of Bankruptcy?

Thank you for completing the Islamic Home Financing form. Someone will contact you shortly to discuss your needs with regards to an Islamic mortgage.