Application Form - Factory Homes Outlet

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By providing application information I agree to have Factory Homes Outlet, Inc and/or it's affiliated finance companies run my application for approval. I understand that a $200 Application Fee will be required to run my application. I also understand this fee is nonrefundable and will apply towards my future purchase with Factory Homes Outlet. This fee can be paid via credit card after clicking 'continue' or you can call a Factory Homes Outlet Representative over the phone at (435) 563-6040 or toll free at (866) 551-7652 to process payment.

• Applicant
• Co Applicant (not required)

Applicant Data

First name:
Last name:
Middle Name or Initial:
Birth date:	Format yyyy-mm-dd
Social Security Number:	Format XXX-XX-XXXX
Maritial status:	--------- Single Married Separated
Number of Dependent Children:
Ages:
Phone number:

Address

Address line1:
Address line2:
City:
State:	--------- Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Zip code:
Ownership status:	--------- Rent Own Live With Relatives Other
How Long Yrs/Mo:

Please include all addresses in the past two years.

• Add an Address
• Remove Last Address

Employer

Current employer:
Employer name:
Work Phone:
City:
State:	--------- Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Gross Salary:
Job Title:
Employer employed from:	Format yyyy-mm-dd
Employer employed to:	Format yyyy-mm-dd

Please add all employers within the last two years.

• Add a Employer
• Remove Last Employer

Credit Information (not required)

Account type:	--------- Checking Savings Investment
Account institution:
Account number:

• Add Institution
• Remove Last Institution

Other Income (not required)

Other income source:
Amount Per Month:

• Add Another Income Source
• Remove Last Income Source

Obligations (not required)

Creditor name:
Phone number:
Account number:
Obligation type:	--------- Mortgage Vehicle Loan Credit Card Student Loan Personal Loan Child Support / Alimony Other
Current balance:
Monthly payment:

• Add Obligation
• Remove Last Obligation

Applicant Signature

Signature:	By typing your name above you certify that you are the applicant of this form, and also agree to the legal notice at the beginning of this form.

Co Applicant Data

First name:
Last name:
Middle Name or Initial:
Birth date:	Format yyyy-mm-dd
Social Security Number:	Format XXX-XX-XXXX
Maritial status:	--------- Single Married Separated
Number of Dependent Children:
Ages:
Phone number:

Co Applicant Address

Address line1:
Address line2:
City:
State:	--------- Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Zip code:
Ownership status:	--------- Rent Own Live With Relatives Other
How Long Yrs/Mo:

Please include all addresses in the past two years.

• Add an Address
• Remove Last Address

Co Applicant Employer

Current employer:
Employer name:
Work Phone:
City:
State:	--------- Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Gross Salary:
Job Title:
Employer employed from:	Format yyyy-mm-dd
Employer employed to:	Format yyyy-mm-dd

Please add all employers within the last two years.

• Add a Employer
• Remove Last Employer

Co Applicant Credit Information (Not Required)

Account type:	--------- Checking Savings Investment
Account institution:
Account number:

• Add Institution
• Remove Last Institution

Co Applicant Other Income (Not Required)

Other income source:
Amount Per Month:

• Add Another Income Source
• Remove Last Income Source

Co Applicant Obligations (Not Required)

Creditor name:
Phone number:
Account number:
Obligation type:	--------- Mortgage Vehicle Loan Credit Card Student Loan Personal Loan Child Support / Alimony Other
Current balance:
Monthly payment:

• Add Obligation
• Remove Last Obligation

Co Applicant Signature

Signature:	By typing your name above you certify that you are the applicant of this form, and also agree to the legal notice at the beginning of this form.

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