Pre Qualification | HomeFirst Certified Communities

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Landstar Homes/Medallion Homes
Pre-Qualification Form

All Fields Required

Applicant's Name:


Last	First	Middle

Current Address:


Street	City	State	Zip Code

Phone Number:

()

Date of Birth:

Social Security Number:

Employer:


Company Name	Time on Job

Monthly Gross Income*:

*All income must be provable

Desired Monthly Payment (include site rent):

Email Address:

Co-Applicant

Co-Applicant's Name:


Last	First	Middle

Current Address:


Street	City	State	Zip Code

Phone Number:

()

Date of Birth:

Social Security Number:

Employer:


Company Name	Time on Job

Monthly Gross Income*:

*All income must be provable

FAIR CREDIT REPORTING ACT NOTICE TO CONSUMER

This will advise you that your credit application will be submitted to Landstar/Medallion Homes for consideration as to whether you meet their credit requirements.

All of the statements made in this application are true and correct and are made for the purpose of obtaining credit. You are authorized to investigate my credit record, to verify my credit, employment and income references and to obtain such other information as you deem necessary and to give credit reporting agencies and other information regarding applicant.

I, hereby, authorize Landstar Homes/Medallion Homes to pull my credit report for the purpose of pre-qualifying me on the purchase of a manufactured home.