PIONEER MOBILE HOMES INC.

These Questions Apply to Both Applicant and Co-Applicant

If a "yes" answer to #1 thru #8, explain in "comments"	Applicant	Co-Applicant
1. In the last 7 years, have you been declared bankrupt?	Yes No	Yes No
2. Have you had property foreclosed upon, or any voluntary repossession ?	Yes No	Yes No
3. Are you a co-maker or endorser of a note?	Yes No	Yes No
4. Are there any outstanding judgments, collections?	Yes No	Yes No
5. Are you obligated to pay alimony, child support, or separate maintenance?	Yes No	Yes No
If "yes" how much per month?
6. Is any part of the down payment borrowed?	Yes No	Yes No
7. Is any part of the down payment a gift?	Yes No	Yes No
8. Have you previously received credit in another name?	Yes No	Yes No
If "yes", please state that name.
9. Are you purchasing this mobile home for another person?	Yes No	Yes No
If "yes", please name person who will live in the mobile home.
If "yes", will that person also be applying for credit in this transaction?	Yes No	Yes No

Contact Information
Home Phone Work Phone
E-mail Address

Comments? Questions?

Thank you for taking the time to complete this application. We look forward to working with you to arrange a financing package that will meet your needs!

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