Palm Harbor Home Loan Application Urbana-Champaign, IL

217-355-5343

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Online Application

Home / Buy a Home / Online Loan Application

Please provide the following information so that your application can be processed. A representative will contact you within 48 hours.

* Fields Are Required
All information provided will be kept strictly confidential.

Prospective Home Address:
When do you want to move?
Are you in a lease?	If yes, when does it expire:
How much can you pay monthly?
What is the most you can raise for a down payment towards your next residence?
Is your down payment available now?
Do you consider your credit Good, Fair, or Poor?
Do you give us permission to order and review your credit report?
	APPLICANT	CO-APPLICANT
Last Name:
First Name:
Middle Initial:
Date of Birth:
Home phone:
Work Phone:
Email Address:
CURRENT ADDRESS		Same
Current Address:
City:
State:
Zip Code:
Landlord/Apt. Complex Name:
Monthly Payment:
Years/Months at Address:
PREVIOUS ADDRESS		Same
Previous Address:
City:
State:
Zip Code:
CURRENT EMPLOYER	Applicant	Co-Applicant
Current Employer Name:
Address & City:
Phone Number:
Years/Months Employed:
Current Position:
Gross Monthly Income:
PREVIOUS EMPLOYER	Applicant	Co-Applicant
Previous employer name:
Address & city:
Phone number:
Years/months employed:
What was your job position:
CHECKING ACCOUNTS		Joint Account
Do you have a checking account?:	Yes No	Yes No
Checking account balance:
SAVINGS ACCOUNTS		Joint Account
Do you have a savings account?:	Yes No	Yes No
Savings account balance:

Bank Names:
Recieve Child Support And/Or Alimony/Social Security Income/Retirement Income?:
Any additional income? How much?:
Payments/Debts	Applicant	Co-Applicant
Total monthly payments for all debts:
Balance you still owe:
What Company/Type of Payment:
What Company/Type of Payment:
What Company/Type of Payment:
What Company/Type of Payment:
What Company/Type of Payment:
Do you have any outstanding:	Applicant	Co-Applicant
Judgements:	Yes No	Yes No
Lawsuits:	Yes No	Yes No
Tax Liens:	Yes No	Yes No

Have you ever filed bankruptcy:	Yes No	Yes No
If so, when?:
When was it discharged?

Have you ever had property foreclosed?:	Yes No	Yes No
When?:

Have you ever had a repossession?:	Yes No	Yes No
When?:

Do you pay Child Support?:	Yes No	Yes No
Amount:

Do you pay Alimony?:	Yes No	Yes No
Amount:

Do you own any real estate?:	Yes No	Yes No
If so, where and what?:

If you have any questions or comments that you feel would help us better evaluate your current financial status please enter them here:
The undersigned specifically acknowledges and agrees that (1) the information provided by me/us is being relied on by Handy Man Buys Houses , Inc. in selling property to me/us: (2) the property will no be used for any illegal or prohibited purpose or use: (3) all statements made in this application are for the purpose of purchasing real property from Palm Harbor Services, Inc. and/or obtaining a loan for the purpose of such real property: (4) verification or any re-verification of any information contained in this application may be made at any time by Palm Harbor Services, Inc.. even if the sale and or loan is not approved: (5) Palm Harbor Services, Inc., it's agents, successors, and assigns will rely on the information contained in this application and I/we have a continuing obligation to amend and/or supplement the information provided in this application if any of the material facts which I/we have represented herein should change prior to closing: (6) I/we understand that misrepresentations will void my/our purchase.
	Applicant	Co-Applicant
Signature:
Date: