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Borrower
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Co-Borrower
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Name:
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E-mail (required)
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Street Address:
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City:
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State:
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Zip:
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# of Years at Address:
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If less than 2 years at current
address, what was your previous address?
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Street Address:
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City:
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State:
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Zip:
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# of Years at Address:
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| Currently Own / Rent:
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Own Rent
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Own Rent
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If owned; what will be the disposition of the property?
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Monthly Payment:
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Home Phone w/ area code:
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Work Phone w/ area code:
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Social Security #:
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Date of Birth:
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Marital Status:
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| Name of Current Employer
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| Self Employed?
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YES
NO
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YES
NO
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| Position:
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Length of Employment:
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Previous employment if current
employment is less than two years?
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Gross Monthly Income:
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Other Income:
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Source of Other Income:
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Approximate Checking Account Balance:
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Approximate Savings Account Balance:
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If you answer YES to any of the questions below use the
text field below for explanations.
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Are there
any Judgments against you or accounts currently in collection?
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YES NO
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Have you
been declared bankrupt within past 7 years?
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YES NO
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Have you
had any foreclosures in the past 7 years?
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YES NO
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Are there
any lawsuits pending against you?
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YES NO
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Are you a
Co-Maker or Endorser on any credit with someone else?
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YES NO
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Will this
home be your primary residence?
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YES NO
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Are you a
U.S. citizen?
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YES NO
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Are you a
permanent resident alien?
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YES NO
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Are you
obligated to pay child support, alimony, or separate maintenance?
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YES NO
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Is any of
the down payment borrowed?
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YES NO
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Have you
had an ownership interest in a property in the last 3 years?
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YES NO
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Explain:
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Loan Information
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Amount Requested:
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Sale price - Home and
Improvements:
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Down Payment Amount:
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Amount of Equity in home
(if refinancing)
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Home Placement
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ParkPrivate Land
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| Retailer's Name:
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| Retailer's Phone #:
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Contact Information
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Best time to reach you:
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Phone number to reach you at that
time:
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How did you hear about us? |
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BY SUBMITTING THIS FORM I AGREE TO THE FOLLOWING:
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I/We have applied to determine my/our pre-qualification for a loan program
with Land Home Financial Services, Inc. In applying for the
pre-qualification status, I/we completed a pre-qualification application
containing various information about personal background in regards to
employment, assets and liabilities. I/We certify that all of the information
is true and complete. I/We made no misrepresentations in the information
provided, nor did we omit any pertinent information.
I/We understand and agree
that Land Home Financial Services, Inc. will verify any information provided.
Such information shall include, but not be limited to, employment history and
income, any and or all deposit accounts; credit history and copies of income
tax returns. I/We authorize Land Home Financial Services, Inc. to obtain
credit information from local and national credit reporting agencies and to
discuss my/our loan program pre-qualification with my/our Builder/Retailer.
I/We fully understand that it is a Federal crime punishable by fine or
imprisonment, or both, to knowingly make any false statements when applying
for a loan, as applicable under the provision of Title 18, United States
code, Section 1014.
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Borrower:
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YES, I
accept the above terms
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Co-Borrower:
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YES, I
accept the above terms
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Date (MM/DD/YY):
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