Credit Application

Credit Application

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

First NameLast Name
Email
example@example.com
Date of Birth

MonthDayYear
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

CityState

Zip Code
County
Mailing Address (if different from physical)

Street Address

Street Address Line 2

CityState

Zip Code
Home Phone Number

Area CodePhone Number
Cell Phone Number

Area CodePhone 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

CityState

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 NumberState / Province

Postal / Zip Code
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

CityState

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

MonthDayYear
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 PaymentState / Province

Postal / Zip Code
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

CityState

Zip Code
Position/Occupation
Self Employed
Date Started

MonthDayYear
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/OccupationCity and State

Date Started / Date Left
Previous Employer

Name

Supervisor name and Phone Number

Position Held/OccupationCity 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
Should be Empty:

Credit Application

Employment History

Debts and Obligations