COUNTRY VIEW
MOBILE-HOME APPLICATION

PERSONAL INFORMATION:

Full Name Phone Number Email Address Social Security # Age Date of Birth Driver’s License # State Spouse's Name Spouse's Phone Spouse's Social Security # Spouse's Age Spouse's Date of Birth Spouse's Driver’s License # Spouse's State

Children's or other individual's names:

Number of individuals that will reside at your home Name Social Security # Date of Birth Age Name Social Security # Date of Birth Age Name Social Security # Date of Birth Age Name Social Security # Date of Birth Age
Present Address Present City Present State

EMPLOYMENT:

Occupation Work Phone How Long? Present Employer Address City State Supervisor Previous Employer Work Phone How long? Address of Employer City State Spouse's Occupation Work Phone How long? Address of Employer City State

PREVIOUS LANDLORD:

Have you rented in the past before? How long? Previous Landlord Address City State Phone number

REFERENCES:

Name Phone Number Address City State Name Phone Number Address City State Name Phone Number Address City State

IN CASE OF EMERGENCY, WHO DO WE CONTACT:

Name Phone Number Address City State

AUTOMOBILE INFORMATION:

Make Model Year License Number State

BANKING INFORMATION

Bank's Name Phone Number Savings Account Number * Checking Account Number * Installment Loan Account Number *

******ALL OF THE ABOVE FINANCIAL INFORMATION WILL BE KEPT STRICTLY CONFIDENTIAL.******

I verify that the information provided is true and correct to the best of my knowledge. I agree to give the management of Country View notice of any changes in the above information within ten (10) days of any change. This includes any changes of individuals residing on these premises.
I furthermore have read the Rules and Restrictions for Country View and if I become a resident, I agree to abide by them or endure the penalties should it deem itself necessary.
FAIR CREDIT REPORTING ACT NOTICE TO CONSUMER
All of the statements made in this application are true and correct and are made for the purpose of obtaining credit. You are unauthorized to investigate my credit record to verified my credit employment and income reference and to obtain such other information as you seem necessary and to five credit reporting agencies and other information regarding your credit experience with me.

Applicant Name Co-Applicant Name

Country View

580-338-5008

Office Hours :

Monday - Friday : 9am-12 & 1pm-5pm

*** Office Closed on Weekends ***

Laundry Hours:

Open Daily : 6:00am - Midnight

Short-term loans up to $700.00
Inquire at the Country View /Country Finance office.

Country View

COUNTRY VIEWMOBILE-HOME APPLICATION

Country View

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COUNTRY VIEW
MOBILE-HOME APPLICATION