Customer Info Sheet for Land Only

Application Date *

Which Property are you interested in? *

--->> AN APPLICATION MUST BE FILLED OUT FOR EVERYONE AGE 19 YRS AND OLDER THAT WILL BE LIVING ON THE PROPERTY

I/We Understand and Agree that I/we must submit an Application for everyone Age 19 Yrs and Older.

(Our application form accepts up to 4 applicants in one submittal. If you have more than 4 applicants that are 19 Yrs and Older, then when you are finished submitting the first application form with 4 applicants, you will need to come back to this site and submit another application form for your remaining applicants)

Total number of Occupants AGE 19 AND OLDER that will be living at the property: *

========== ADULT # 1 ========== *

First

Middle

Last

Marital Status *

Married
Single

Social Security # *

Birth Date *

Drivers License # & State *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Cell Phone *

Home Phone *

Work Phone *

Email Address *

Confirm Email

YOUR Monthly Income (DO NOT Include Spouse Income) *

Relation to you? *

Cell Phone *

Home Phone *

Email Address *

Confirm Email

Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

======== HOME INFO

Your current living situation: *

Own a Home
Rent
Live with Family
Other

How long at your current address? *

Do you plan on putting a Home on the property? *

No - Not at this time
Yes - A Manufactured Home
Yes - A Site-Built Home

*** Some properties do not allow Manufactured Homes and some properties do not allow Site-Built Homes. Be sure to speak to our Agent to be sure you are looking at the property that best suites your needs.

======== ADDITIONAL OCCUPANTS - Children

NUMBER OF CHILDREN YOUNGER THAN AGE 19 THAT WILL BE LIVING WITH YOU *

(REQUIRED WHETHER THEY LIVE WITH YOU PART-TIME OF FULL-TIME)

======== PETS / ANIMALS

PETS / ANIMALS *

Yes - I Understand and Agree

Whether I currently have pets, or will have pets in the future - I am aware that there is a Lease Law and agree to abide by all City, County, State, Government Laws and Regulations pertaining to owning a pet, including but not limited to, proper vaccinations, containment, shelter, etc; as well as any Rules or Regulations dictated by and HOA that may be active in my neighborhood; so my pets do not become a nuisance or danger to my neighbors.

PETS / ANIMALS - Please check all that apply *

Dogs
Cats
Other
NONE - I do not have pets at this time

======== VEHICLES

VEHICLES *

No - I will not have any sort of large or commercial vehicle on the property
Yes - I Understand and Agree

Other than regular vehicles (Cars, Trucks, Motorcycles, Etc) will you have any sort of large of commercial vehicle on the property, regardless if you are the owner or if it is a work vehicle owned by your employer. ---- ** PLEASE BE AWARE THAT YOU MAY NOT PARK IT ON THE SIDE OF THE ROAD, OR ON ANOTHER PROPERTY. -- IT MUST ONLY BE PARKED ON YOUR PROPERTY. ---- You must be sure that your vehicle is not damaging the road or any culverts, etc or you will be responsible for the cost of repairs. ---- For example: RV, Big-Rig, 18-Wheeler, Delivery Truck, School Bus, City or County Vehicle, Squad Car, Etc

======== BANKING INFORMATION

Name of your Bank - City & State *

First

Last

What kind of Bank Accounts do you have? - Please check all that apply. *

Checking
Savings
Other

Are you willing to let us draft your monthly payment each month? *

Certainly - No Problem
Possibly - I'll Consider It
Hard Pass - No

======== LEGAL INFORMATION

Are you, your spouse, significant other or a member of your household currently in Bankruptcy, or have filed in the last 7 years? *

Have you, your spouse, significant other or a member of your family or household ever been evicted or asked to leave a residence or rental property? *

Have you, your spouse, significant other or a member of your family or household ever willfully refused to make a mortgage payment or pay rent when it was due, or left owing a balance? *

Have you, your spouse, significant other or a member of your family or household ever been adjudicated a sex offender? *

Have you, your spouse, significant other or a member of your family or household ever been charged with a crime (other than a traffic violation)? *

Are you, your spouse, significant other or a member of your family or household subject to tax liens, garnishments, withholding orders, or any other type of court-ordered collection activity? *

CLAUSE A: *

I have read Clause A - I Understand and Agree

I/We, the undersigned, understand that Power Real Estate is the Sellers Agent and representative for the Owner/Landlord and that the Selling Agent's fees will be paid by the Owner/Landlord. The undersigned acknowledge(s) that this written notice was received prior to the undersigned receiving a deed or lease option agreement.

CLAUSE B: *

I have read Clause B - I Understand and Agree

I/We, the undersigned, declare the foregoing information is complete and accurate to the best of my/our knowledge. I/We hereby authorize you or your representing agents, to use all of the above information to approve or disapprove my/our offer, including the right to make independent investigations of current or past employment history, credit references, and public records. I/We, the undersigned, understand that giving false information is a serious criminal offense and that a misrepresentation on this document can result in legal action against you.

CLAUSE C: *

I have read Clause C - I Understand and Agree

I/We, the undersigned, understand that failure to close on the property after the offer has been approved will result in the deposit being retained as liquidated damages. All deposits placed on the property after the offer is approved are Non-Refundable as well.

ADULT # 2 - Signature *

ADULT # 3 - Signature *

ADULT # 4 - Signature *

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Main Content

======== HOME INFO

======== ADDITIONAL OCCUPANTS - Children

======== PETS / ANIMALS

======== VEHICLES

======== BANKING INFORMATION

======== LEGAL INFORMATION

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