All fields in
RED are
required. You must select an answer in order to submit the
application .
Please select
the salesperson you are working with. If you have not visited
one of our Sales Centers please select "None".
Salesperson Woody Joe Bob
Don G
Jonette Jerry
Kathy
Ryan
None
PART 1 -
Your Personal Profile Are you Married
Unmarried
Separated
If you are applying for
credit jointly,
please fill out another
application for
the co-applicant.
First Name
Middle Name
Last Name
E-Mail Address
Your Date of Birth
Social Security Number
Current Address
City
State
Zip Code
Your Telephone Number
Landlord's Name (if
applicable)
Landlord's Telephone Number (if
applicable)
At your current address, do
you?
Rent Own How
Long?
Please indicate if you want to live in a Park
Community or on Private Land
If Park, please type park name
Park Location
If Private Land, have you purchased land
yet?
If purchased, amount owing
$
To whom is the amount owed?
Current Employer
Date Hired
Gross Monthly Salary
$ If self-employed, enter adjusted gross income (most
recent tax forms)
Number of Dependants
IMPORTANT: YOU DO NOT HAVE TO INCLUDE INFORMATION ON INCOME
FROM ALIMONY, CHILD SUPPORT OR SEPARATE MAINTENANCE UNLESS YOU WANT
US TO CONSIDER IT IN GRANTING
CREDIT . IF
YOU WISH US TO RELY ON SUCH INCOME, IT SHOULD BE INCLUDED IN THIS
SPACE FOR OTHER INCOME:
Other Income:
Source of
Income
PART 2 -
Additional Source/Type of
Income
Other Income:
Date First
Received
$
CREDIT
DISCLOSURE STATEMENT
I agree by checking the
"round box" below to allow
Northgate Homes , Inc. to
investigate my credit
background in order to ascertain my
credit
worthiness and limited power of attorney to assign my name if
submitted to one or more lenders for
credit approval
purposes.
By
Checking This Box I Authorize Disclosure of this
Information
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 observations
or surname. If you do not wish to furnish the above
information, please check the square 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).
BORROWER: I do not
wish to furnish this information
Ethnicity
Hispanic
or Latino
Not Hispanic or Latino
Race
American Indian
or Alaska Native
Asian
Black/African American
Native
Hawaiian or Other Pacific Islander
White
SEX
Female
Male
BY CHECKING THIS ROUND
BOX, UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE EXAMINED THE
TAX IDENTIFICATION NUMBER AND THE SECTION ON CITIZENSHIP TO THE BEST
OF MY KNOWLEDGE AND BELIEVE THEY ARE TRUE, CORRECT AND COMPLETE.
APPLICANT'S STATEMENT: I HAVE ANSWERED THE QUESTIONS IN
THIS APPLICATION
FULLY AND TRUTHFULLY. I UNDERSTAND THAT YOU MAY CHECK MY
CREDIT RECORD
AND ANY STATEMENTS I MADE. I GIVE ALL MY CREDITORS PERMISSION
TO GIVE YOU ANY INFORMATION YOU NEED TO DETERMINE
WHETHER
TO GRANT
ME CREDIT .
BY CHECKING THIS
ROUND BOX YOU GIVE YOUR PERMISSION TO ANY FINANCIAL INSTITUTION TO
INVESTIGATE YOUR CREDIT AND EMPLOYMENT HISTORY AND YOU AUTHORIZE
RELEASE OF ALL CREDIT-RELATED INFORMATION TO THOSE INSTITUTIONS.
YOU ALSO AGREE TO INQUIRE ABOUT THE STATUS OF YOUR CREDIT
APPLICATION BY CONTACTING NORTHGATE HOMES, INC AND UNDERSTAND THAT
THIS APPLICATION MAY BE CONSIDERED WITHDRAWN IF YOU DO NOT INQUIRE
ABOUT ITS STATUS WITHIN 30 DAYS OF THIS NOTICE. IF YOUR
APPLICATION IS DECLINED YOU WILL BE NOTIFIED WITHIN 30 DAYS.
ENTER
TODAY'S DATE