PIONEER CUSTOM HOMES INC. MOBILE HOMES

GET PRE-QUALIFIED FOR A MOBILE HOME LOAN
These Questions Apply to Both Applicant and Co-Applicant

Applicant Information	Co-Applicant Information
Applicant Home Phone	Co-Applicant Home Phone
Last Name	Last Name
First Name MI.	First Name MI.
Address	Address
City	City
State Zip	State Zip
Rent Own Other How Long?	RentOwn Other How Long?
Social Security Number	Social Security Number
Date of Birth No. of Dependents	Date of Birth No. of Dependents
MarriedUnmarriedSeparated	MarriedUnmarriedSeparated
Nearest Relative (not living with you) and Relationship Relationship	Nearest Relative (not living with you) and Relationship Relationship
Nearest Relatives Home Phone	Nearest Relatives Home Phone

"Applicant's Income"	*"Co-Applicant's Income"*
Hire Date for Current Employer	Hire Date for Current Employer
Employers Name	Employers Name
Employers Phone	Employers Phone
Monthly Salary (Pre-Tax)	Monthly Salary (Pre-Tax)
Other Monthly Income	Other Monthly Income
Monthly Credit Card Pmts	Monthly Credit Card Pmts
Other Monthly Loans/Pmts	Other Monthly Loans/Pmts

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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