APPLICANT INFORMATION
Email Address
*
Social Security #
*
Date of Birth
*
Full Name
*
Current Physical Address
*
City/State
*
- - Choose One - -
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip code
*
Time At This Address
Housing Status
*
Choose One
Own
Rent
With Family
HOME Phone
*
Mobile Phone
U.S. citizen?
*
Choose One
Yes
No
Name of Mortgage Co.
*
Payment or Rent
*
.00
Previous address (if at present address less than two years)
Address
City, State
- - Choose One - -
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip code
Employment Data
Present employer
*
Employer's business
*
Telephone number
*
Time on job
*
Position held
*
Salary
*
.00 per*
Choose One
Week
Month
Year
Supervisor's Name
Other sources of income (describe)
Amount of other income
.00 per
Choose One
Week
Month
Year
Note: Alimony, Child support or separate maintenance income need not be revealed if you do not choose to rely upon it as a basis for repaying this obligation.
CO-APPLICANT (IF APPLICABLE) MUST BE PRESENT AT CLOSING** **ALL FIELDS ARE REQUIRED**
U.S. Citizen?
Choose One
Yes
No
Name: (full)
Social Security Number
Date of birth
City, State: (place of birth)
- - Choose One - -
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Address
City, State
- - Choose One - -
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip code
Own or Rent?
Choose One
Own
Rent
How long
Telephone Number
Present employer
Telephone number
Time on job
Position held
Salary
.00 per
Choose One
Week
Month
Year
Other sources of income (describe)
Amount of other income
.00 per
Choose One
Week
Month
Year
Lending Information
The lending institutions must have a basis to compute the approval amount. If you are still undecided on a particular unit, please fill in the information on one of our units that best matches your needs and in the price range you desire.
Year
*
Make
*
Model
*
Price
*
Down Payment
*
Do you have a Trade In?
*
Yes
No
If Yes, complete the following:
Year
Make
Model
Length
Engine
Mileage
Payoff Amount
Lien Holder
Comments - Vehicle you are interested in, Down Payment, Explanations, Special Circumstances
Salesman
Please note: All information contained in this application may be distributed to four major lending institutions and is not distributed in any other manner. All information is kept confidentially within Motor Home Specialist written files and may be saved to floppy disk or CD.
Statement of Consent
By completing this electronic application and pressing the Submit button, I hereby certify that the information provided by me is correct. I also authorize the check of my credit with credit reporting agencies. Failure to provide all information requested can delay this application.