Credit Application

Credit Application

Please complete all fields.
Please select a representative to forward your application to from the dropdown list *
Name *

First Name Last Name
Email *
example@example.com
Date of Birth *

Month Day Year
Date
SSN or ITIN *
Approximate Credit Score *
Marital Status *
Number of Dependants *
Dependents Age(s)
Seperated by comma
Current Street Address *

Street Address

Street Address Line 2

City State

Zip Code
County *
Mailing Address (if different from physical)

Street Address

Street Address Line 2

City State

Zip Code
Home Phone Number

Area Code Phone Number
Cell Phone Number *

Area Code Phone Number
Length at Present Address *
Years, Months
Residential Status *
Monthly Mortgage/Rent Amount *
Name and Phone Number of Landlord/Mortgage Holder
Previous Address (if current address is less than 3 years)

Street Address

Street Address Line 2

City State

Zip Code
How long at previous address
years, months
Name and Phone Number of Previous Mortgage Holder or Landlord
Name of Nearest Relative NOT Living with you *

First, Middle, Last

Relationship

Phone Number
Desired Home Model or Description *
Property will be *
Desired Loan Type *
Street Address where home will be located (Including site number) *

Street Address

Site Number

City State

Zip Code
If Land and Home or Land as Down Payment, Land is
Name and phone number of Land Owner
Land Value
Purchase Price/Payoff Amount
Date Land Acquired

Month Day Year
Date
If Home only, Site Placement is
If Home Only and Land is Leased

Name of Community/Park/Land Owner/Mortgage Holder

Phone Number

Monthly Site Payment
Proposed Down Payment Amount *
Source of Down Payment *
If gift, from whom:
Employment History

Minimum Three years Required
Current Employer *
Employer Address *

Street Address

Street Address Line 2

City State
Position/Occupation *
Self Employed *
Date Started *

Month Day Year
Date
Supervisor Name and Phone Number *
How are you paid *
Hourly Rate
Average Hours per Week
Monthly Income Amount *
Bonus amount in last 12 Months
Commission Amount in last 12 Months
Second or Previous Employer

Name

Supervisor name and Phone Number

Position Held/Occupation City and State

Date Started / Date Left
Previous Employer

Name

Supervisor name and Phone Number

Position Held/Occupation City and State

Date Started / Date Left
Please provide an explanation for any job gaps greater than 30 days
Other Income Source and Monthly Amount
Checking Account Institution
Savings Account Institution
Debts and Obligations
List Any Debts not on Your Credit Report
Do you PAY anyone Child Support *
Do you PAY anyone Alimony *
Do you have any amount garnished from you income *
Are you a US Citizen *
Are you a permanent resident alien *
Have you declared bankruptcy within the last 5 years *
Please verify that you are human *
Signature *

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Should be Empty:

Credit Application

Employment History

Debts and Obligations