House Size	Single Wide Double Wide Other
House Model Year	(Homes older than 1977 must have land and apply by phone.)
Name:
Address:
City:
State:	AL AR AZ CA CO DE DC FL GA ID IL IN IA KS KY LA MD ME MI MN MS MO MT NE NM NY NC ND OH OK OR PA SC SD TN TX UT VA WA WV WI WY AK, CT, HI, MA, NH, NJ, NV, RI, and VT and parts of southern CA not serviced, including: Kern, Ventura, Santa Barbara, San Bernadino, Los Angeles, Orange, Riverside, San Diego and Imperial counties.
Zip:
Home Telephone:
Work Telephone:
Email:
Best Contact Time:	Morning Afternoon Evening
Credit History:	Clean Credit History Minor Credit Problems Major Credit Problems
Have you had a bankruptcy, judgment, or repossession in the last four years?	yes  no
Credit Score
	Must have a 625+ Credit Score for Processing.
Additional Information or Requests: