First Name
Last Name
*SSN ( REQUIRED)
Co-applicant first name
Co-applicant last name
Co-applicant SSN ( if applicable)
Street
City
State
Select... AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA DC WV WI WY
Zip
Home Phone
Work Phone
Email
BK in the last 7 years?
Yes No
Years at current residence
Years at current Job
Applicant's monthly income
$
Co-applicant's monthly income
$
Other monthly income
$
Do you currently rent or own
Select... Rent Own
Auto #1 Payment
$
Auto #2 Payment
$
Total monthly payments for all credit cards
Current monthly rent/ mortgage
Current monthly space rent
Other monthly payments
Numbers of bedrooms needed
Ready to move:
Select... ASAP 30-60 days 60-90 days 90+
Have you seen any homes that you like?
Yes No
If yes, where?
Initial down payment you have available $
Desired monthly payment $
I have a manufactured home to trade in
Yes No
I am looking for a home in a
Select... Family Community Senior Community Private Property
Have you visited a 5 Star Homes display center before?
Yes No
If you have visted, who did you talk with?
How did you find out about us?
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 discriminate neither on the basis of this
information, nor on whether you choose to furnish it. If you furnish the
information, please provide both ethnicity and race. For race, you may check
more than one designation. If you choose not to furnish it, under Federal
regulations this Lender is required to note ethnicity, race and sex on the basis
of visual observation or surname. If you do not wish to furnish the above
information, please check the box below. (Lender must review the above material
to assure that the disclosures satisfy all requirements to which the Lender is
subject under applicable state law for the particular type of loan applied for.)
Ethnicity
Select... Do not wish to furnish Hispanic or Latino Not Hispanic or Latino American Indian or Alaska Native Black/African American Asian White Native Hawaiin or Pacific Islander
Gender
Select... Male Female
Co-Applicant Ethnicity
Select... Do not wish to furnish Hispanic or Latino Not Hispanic or Latino American Indian or Alaska Native Black/African American Asian White Native Hawaiin or Pacific Islander
Gender
Select... Male Female
Best Number to Fax to? ( if necessary)
Questions or Comments?
By clicking the submission button below, I / We warrant the information
furnished is truthful, accurate and supplied voluntarily and therefore
authorizes you at your option to check my / our credit and employment histories
and bank references, to answer questions about our credit history with me / us,
and to keep this application whether or not it is accepted.