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Today's Date:
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How did you find out about us? (Web search, Craig's List, Flyer, Google, Kijiji, Sign, etc.)
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First Name:
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Last Name:
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Social Security Number:
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Date of Birth:
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Street Address:
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City, State:
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Zip Code
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Previous address if less than 2 years at current address:
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Primary Phone:
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Alternate Phone:
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Email Address:
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Current Employer:
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Work Phone:
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How long with current employer?
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Previous Employer if less than 2 years with current employer:
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Gross Monthly Income (Before Taxes):
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Do you have any other sources of income such as child support, SSI, retirement benefits, etc.?
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If yes, what kind and how much do you receive?
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Do you already own land?
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Have you had a bankruptcy within the last 2 years?
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Have you had an auto repossessed within the last 2 years?
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Are you responsible for child support payments?
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If yes, are these payments current?
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Are you currently deliquent on any federal debt (i.e. student loans, deliquent taxes)?
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Co Applicant's First Name:
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Co Applicant's Last Name:
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Co Applicant's Social Security:
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Co Applicant's Date of Birth:
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Co Applicant's Current Employer:
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Previous Employer if less than 2 Years:
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Co Applicant's Gross Monthly Income (before taxes):
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Are you interested in a home only or a land/home package?
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How many bedrooms are needed?
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How much would you like your monthly payments to be?
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How much would you like to put down?
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Please list any special requirements for your new home:
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The information collected above will be submitted to credit reporting agencies. By clicking the submit button I understand and agree the information provided is true and correct to the best of my knowledge and will be used for the purpose of verifying credit information, employment, income, and other information necessary.
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