SECTION 1: DEALER INFORMATION
SECTION 2: APPLICANT
PERSONAL INFORMATION
NOTE: Alimony, child
support, or separate income does not need to be revealed unless you want it
considered for repayment of this obligation.
I hereby declare that all of
the statements made are true and correct. For the purpose of obtaining
credit, the creditor is authorized to investigate my credit record, to
obtain a credit report, to verify my credit, employment and income
reference, to obtain such other information as the creditor deems necessary
and to give credit reporting agencies (credit bureaus) and others
information regarding the creditor's credit experience with me.
SECTION 3: CO-APPLICANT
PERSONAL INFORMATION
NOTE: Alimony, child
support, or separate income does not need to be revealed unless you want it
considered for repayment of this obligation.
I hereby declare that all of
the statements made are true and correct. For the purpose of obtaining
credit, the creditor is authorized to investigate my credit record, to
obtain a credit report, to verify my credit, employment and income
reference, to obtain such other information as the creditor deems necessary
and to give credit reporting agencies (credit bureaus) and others
information regarding the creditor's credit experience with me.
SECTION 4: MANUFACTURED HOME INFORMATION
SECTION 5: LOAN TYPE
INFORMATION
SECTION 6: SALES
INFORMATION
SECTION 7: LAND / HOME
COMBINATION
SECTION 8: 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 disclosures 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 do not furnish ethnicity, race, or sex,
under Federal regulations, this lender is required to note the information
on the basis of visual observation or surname. If you do not wish to furnish
the 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.)
To be
completed by the interviewer (retailer).
The application was taken by:
FACE TO FACE INTERVIEW
MAIL
TELEPHONE
INTERNET
SECTION
9: DEALER COMMENTS