Mortgage Broker Client Intake Form

Mortgage Broker Client Intake Form — Form Fields

This real estate template includes 11 fields. Collect initial financial and personal information from prospective mortgage clients to begin the loan process. Free to customize and use on ZenBuild.

• Full Name (text, required)
• Email Address (email, required)
• Phone Number (text, required)
• Loan Purpose (dropdown selection, required) — options: Purchase, Refinance, Cash-Out Refinance, Home Equity
• Estimated Property Value or Purchase Price (USD) (number, required)
• Down Payment Amount or Equity Available (USD) (number, required)
• Credit Score Range (dropdown selection, required) — options: 760+, 720–759, 680–719, 640–679, 600–639, Below 600, Not sure
• Employment Status (dropdown selection, required) — options: Salaried/W-2, Self-Employed, Retired, Government/Military, Other
• Gross Annual Household Income (USD) (number, required)
• Have you filed for bankruptcy in the past 7 years? (multiple choice, required) — options: Yes, No
• Additional details or questions (long text, optional)