This application must be filled out completely. We will notify you within 5 business days.

Part I APPLICANT
You are not required to disclose income from Alimony, Child Support, or Separate Maintenance, unless you want us to consider it in connection with this application.

First Name:
Middle Initial:
Last Name:
Date of Birth: / /
Present Address:
City:
County:
State:
Zip:
Length of Residence
Is this your primary residence? Yes No
Previous Address (if less than 5 years at present address):
City:
State:
Zip:
Length of Residence:
Social Security Number:
Email Address:
Phone Number: ( ) -
Cell Phone Number: ( ) -
Employer:
Position:
Hire Date: / /
Monthly Gross Income: $
Business Phone: ( ) - Ext
Previous Employer:
Previous Position:
Hire Date: / /
Business Phone: ( ) - Ext
Additional Yearly Income: $
Source of Additional Yearly Income:
Number of dependents (excluding co-ap):
Child Support Obligations: $
 
Part II CO-APPLICANT
You are not required to disclose income from Alimony, Child Support, or Separate Maintenance, unless you want us to consider it in connection with this application.
First Name:
Middle Initial:
Last Name:
Date of Birth: / /
Social Security Number:
Was co-applicant on the original loan: Yes No
Employer:
Position:
Hire Date: / /
Monthly Gross Income:
Business Phone: ( ) - Ext
Cell Phone: ( ) -
Previous Employer:
Previous Position:
Hire Date: / /
Business Phone: ( ) - Ext
Additional Yearly Income: $
Source of Additional Yearly Income:
Number of dependents:
Child Support Obligations: $
 
Part III FINANCIAL INFO
Checking Bank:
Savings Bank:
Present Lienholder:
Current Balance:
Monthly Payment: $
Current Rate:
Due Date:
Remaining Term:
Fixed or Variable: Fixed Variable
Insurance:
 
Part IV- DESCRIPTION OF COLLATERAL & LOCATION
Refinance amount:  
Original Purchase price of home:
Make:
Model:
Year: (At this time, we cannot finance chattel loans prior to 1976)
Value:
Width:
Length:
Does home have to be moved? Yes No
Land Type: Park Owned Leased
Park Name:
Park Number:
Lot Rent: $
 
Part V-INFORMATION FOR GOVERNMENT MONITORING PURPOSES
The following information is requested by the federal government for certain types of loans related to a dwelling in order to monitor the Lender's compliance with Equal Credit Opportunity, Fair Housing and Home Mortgage Disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a Lender may not discriminate on the basis of this information, or on whether you choose to furnish it. However, if you choose not to furnish the information and you have made this application in person, under federal regulations the Lender is required to note race or national origin and sex on the basis of visual observation or surname. If you do not wish to furnish the information, please check below.
Applicant: I do not wish to furnish this information
Race or National Origin:

American Indian
Asian, Pacific Islander
Black
Hispanic
White
Other (specify)

Marital Status: Married
Unmarried
Separated
Sex: Male Female
   
CO-Applicant: I do not wish to furnish this information
Race or National Origin:

American Indian
Asian, Pacific Islander
Black
Hispanic
White
Other (specify)

Marital Status: Married
Unmarried
Separated
Sex: Male Female
   
NOTICE to Ohio Applicants: The Ohio Laws against discrimination require that all creditors make credit equally available to all creditworthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law.

NOTICE to Washington State Applicants: Please let us know is we should investigate credit references and/or credit history under another name.

YOU WARRANT THAT THE INFORMATION YOU ARE FURNISHING ABOVE IS TRUE, ACCURATE, SHPPLIED VOLUNTARILY, AND NOT MISLEADING. YOU AUTHORIZE US, AT OUR OPTION: TO CHECK YOUR CREDIT AND EMPLOYMENT HISTORIES AND CREDIT REFERENCES: TO ANSWER QUESTIONS ABOUT YOUR CREDIT HISTORY WITH US; AND TO KEEP THIS APPLICATION WHETHER OR NOT IT IS APPROVED. WE MAY OBTAIN CONSUMER CREDIT REPORTS PERIODICALLY FROM ONE OR MORE CONSUMER REPORTING AGENCIES (CREDIT BUREAUS) IN CONNECTION WITH YOUR APPLICATION AND ANY UPDATE, RENEWAL, REFINANCING, MODIFICATION OR EXTENSION OF THE CREDIT. WE OR ANY AFFILIATE OF OURS MAY OBTAIN ONE OR MORE CONSUMER CREDIT REPORTS ON YOU FROM TIME TO TIME FOR ANY LEGITIMATE BUSINESS PURPOSE. IF YOU ASK, YOU WILL BE TOLD WHETHER A CREDIT REPORT WAS REQUESTED, AND IF SO, THE NAME AND ADDRESS OF ANY CREDIT BUREAU FROM WHICH WE OBTAINED YOUR CREDIT REPORT. WE MAY ALSO VERIFY YOUR EMPLOYMENT, PAY, ASSETS AND DEBTS. YOU AGREE THAT ANYONE RECEIVING A COPY OF THIS IS AUTHORIZED TO PROVIDE US WITH SUCH INFORMATION.

  I AGREE I DISAGREE

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Broker name and phone number
Promotion code
   
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