First Name:
Last Name:
Street Address:
Address (cont.):
City:
State:
Zip Code:
Contact Phone:
E-mail:
Loan Options:	Purchase  Refinance  Debt-Consolidation
Only If Purchase: New Site Address,  Seller Name and Phone Number, Sales Price:	New Site Address: Seller Name: Seller Phone Number: Sales Price:
Home Type:	Manufactured  Mobile
Home Make/Model/Size (ft.Xft.):	Make: Model: Size (ftXft):
Your Original Purchase Price:
Park Name:
Space Rent:
Employer:
Employer Phone Number:
Date of Birth:	Month January February March April May June July August September October November December Day Year
Occupation:
How long at current Occupation:	Years Months
Gross Monthly Income:
How Long at current Residence:	Years Months
Current Lender:
Current Monthly Home Payment:
Term of Loan:
Down Payment if Purchase:
Current Home Loan Rate:
Current Home Loan Balance:
Year Home Built:
Employment History (Last Five Years):
Residence History (Last Five Years):
Monthly Payments to Creditors:
Have you ever experienced bankruptcy?	No Yes
If yes, date of discharge	Month Year
Have you ever experienced repossession, collections or late payments to creditors?	No Yes
If yes, date of last occurance	Month Year
Best phone number to contact you:
Good time to contact you:	Day Night Anytime
Where did you hear about us?
Promo Code:
Please read our Terms of Service:	PLEASE READ: I/we certify that all statements made in this application are true and correct and are made for the purpose of obtaining credit. I/we also certify that I/we are of legal age to enter into this transaction. You and any other party on this transaction authorize FSU to investigate my/our credit record, to verify my/our credit, employment and income references and to obtain any information as you deem necessary and to provide credit reporting agencies and others information regarding your credit experience with me/us. I/ we understand that I/we may submit my/our credit application by fax or phone. I understand that FSU cannot guarantee that third parties will not intercept data being submitted. FSU has taken every reasonable security precaution to protect our information by providing a secured site, however will not be held liable should a third party interception occur. I hereby agree to the terms and conditions of applying on-line with FSU. Thank You, FSU- Customer Service
I have read and agree with the terms and conditions.