Please tell us about yourself:

        First Name: 
      Last Name: 
 Street Address:  Apt: 
           City: 
          State: 
       Zip Code: 
        Country: 
         E-Mail: 

      Telephone: 
            FAX: 

   Best Time to
    Contact You:  At work: At home: 
  Date of Birth: 
  Soc. Sec. No.: 

Briefly describe the mobile home/manufactured house you are interested in and any property information:

Mobile Home Location City: 
      Community Park Name: 
                    State: 
         Mobile Home Size: 
 Mobile Home Manufacturer: 
        Mobile Home Model: 
               Model Year: 
Mobile Home Lot Size if Land is being Financed: 
           Community Park Rent (if applicable): 

Indicate which type(s) of loan program and services you are interested in:

      Refinance Existing Loan
      Home Equity Loan
      Free Pre-Qualification
      Conventional Fixed Rate Loans
      Construction Loans

Additional Comments:

Describe your current housing situation:

I currently own my home:   I currently rent: 
I currently pay per month for Rent/Mortgage: 

If you are a home owner please tell us about your mortgage:

My home is worth: 

I owe on my home. I have a:

      Fixed Rate Mortgage at:  interest
      Variable Rate Mortgage currently at:  interest

Refinancing Needs:

      My primary Residence (I live here)
      Secondary Residence/Vacation Property

Income and Expenses:

My Gross Monthly Income is per month: 

My monthly debt (i.e., Credit Cards, Car Payments,
Loan Payments, Alimony, Child Support, etc...) is: 

Your Credit Profile:

(This is NOT disqualifying information. It helps us put you on the fast track to owning your own home.)

I have had some credit concerns in the past such as:

      Repossessions
      Liens
      Bankruptcy
      Late Payments due to layoffs or illness