SAMAD Home Finance, LLC
  
 
Islamic Home Finance: Pre-Qualification Form
 
 Lessee Information
* Name of Lessee : 
  
* Email : 
  
* Address : 
  
* City : 
  
* State : 
  
* Zip Code : 
  
* Home Phone : 
  
Business Phone : 
  
Social Security No : 
  
DOB :   
Age :   
Professional :   
Marital Status :   
Name of Employer : 
  
Year at this employment : 
  
Previous Employer : 
  
Year at this employment : 
  
* Monthly Income($) : 
  
 Co-Lessee Information (if applicable)
Name of Co-Lessee :   
 Address : 
 
 City : 
 
State : 
 
 Zip Code : 
 
 Home Phone : 
 
Business Phone : 
  
Social Security No : 
  
DOB :   
Age :   
Professional :   
Marital Status :   
Name of Employer : 
  
Year at this employment : 
  
Previous Employer : 
  
Year at this employment : 
  
 Monthly Income($) : 
 
Do you presently own or rent ? 
  
Are you presently purchasing or refinancing ? 
   Purchase. Refinance.
Price Range($) : 
  
What % of on account payment can you make ?($) : 
  
  Please answer the following questions ?
Have you ever been late in any monthly payment(s) : 
  No   Yes
How many credit cards and loans do you have ? 
   Credit Card. Loan.
What is the total amount of monthly payment you make against your credit cards and loans ?($) : 
  
What was the score of the last pulled credit report :