Horizon Homes Credit Application

5115 Kent Junction Road

Norton, VA 24273

(540) 679-2585

Fax: (540) 679-5430

Print and mail or fax to us at the above address or fax number.

Full Name_______________________________Address ________________________________

Phone Number __________________Social Security #______________ Date of Birth ___________

Marital Status ______________________ # of Children_____ Ages_____ _____ ____ _____

How long at present address? __________Check one: ____ Home Owner ____ Renter ____Other

Monthly Rent or Mortgage Payment $_________ Balance of Mortgage $___________

Landlord/Mortgage Holder’s Name _________________________________________

Previous Address (if present address is less than 3 years)_______________________

_____________________________________________________________________

Employer’s Name ___________________________Employer’s City & State ________________________

Phone # ________________Type of Business _________________Supervisor _____________________

Self Employed? Y or N Monthly Salary $_______________ Net or Gross? ________

Job Title or Occupation __________________ Hire Date ________________________

Previous Employer (if present is less than 3 years) _____________________________

Employed from _____________ to _______________ Phone # ___________________

Previous Employer Address _______________________________________________

Other Income (Alimony, Child Support or Separate Maintenance incomes do not have to be revealed unless the applicant wishes to have such sources considered as a basis for repayment of the requested credit)

Source of Other Income ________________________Amount Monthly $____________

Checking Account with (Name & Address)_____________________________________

Savings Account with _____________________________________________________

Last vehicle financed by _______________________ Monthly Payment $____________

Date purchased _____________________________ Present Balance $_____________

Other Obligations (including liability for alimony or child support, credit cards, and all open accounts)

_____________________________ Monthly Payment $_____________ Balance $___________

_____________________________ Monthly Payment $_____________ Balance $___________

_____________________________ Monthly Payment $_____________ Balance $___________

Nearest Relative not living with you _______________ relationship ________________Phone #_______________

The undersigned intend to occupy the property as their primary residence _____Yes ____No

Have you declared bankruptcy within the past 3 years? _____Yes _____No

Have you had any judgements, repossessions, or garnishments against you in the last 7 years? _____Yes ______No

Applicant Signature X_____________________________ Date _______________________

Phone Number __________________Social Security #______________ Date of Birth ___________

Marital Status ______________________ # of Children_____ Ages_____ _____ ____ _____

How long at present address? __________Check one: ____ Home Owner ____ Renter ____Other

Monthly Rent or Mortgage Payment $_________ Balance of Mortgage $___________

Landlord/Mortgage Holder’s Name _________________________________________

Previous Address (if present address is less than 3 years)_______________________

_____________________________________________________________________

Employer’s Name ___________________________Employer’s City & State ________________________

Phone # ________________Type of Business _________________Supervisor _____________________

Self Employed? Y or N Monthly Salary $_______________ Net or Gross? ________

Job Title or Occupation __________________ Hire Date ________________________

Previous Employer (if present is less than 3 years) _____________________________

Employed from _____________ to _______________ Phone # ___________________

Previous Employer Address _______________________________________________

Other Income (Alimony, Child Support or Separate Maintenance incomes do not have to be revealed unless the applicant wishes to have such sources considered as a basis for repayment of the requested credit)

Source of Other Income ________________________Amount Monthly $____________

Checking Account with (Name & Address)_____________________________________

Savings Account with _____________________________________________________

Last vehicle financed by _______________________ Monthly Payment $____________

Date purchased _____________________________ Present Balance $_____________

Other Obligations (including liability for alimony or child support, credit cards, and all open accounts)

_____________________________ Monthly Payment $_____________ Balance $___________

_____________________________ Monthly Payment $_____________ Balance $___________

_____________________________ Monthly Payment $_____________ Balance $___________

Nearest Relative not living with you _______________ relationship ________________Phone #_______________

The undersigned intend to occupy the property as their primary residence _____Yes ____No

Have you declared bankruptcy within the past 3 years? _____Yes _____No

Have you had any judgements, repossessions, or garnishments against you in the last 7 years? _____Yes ______No

Co-Applicant Signature X_____________________________ Date _______________________