Home ยป Customer Info Sheet for Land Only Customer Info Sheet for Land Only Please enable JavaScript in your browser to complete this form.Application Date *Please share how you heard about us - we would like to thank whoever sent you our way. *Power Real Estate WebsiteSignage on StreetSocial MediaLocal CompanyGoogle SearchPaper AdvertisementWord of MouthOtherWhich Social Media Platform? *Which Local Company - and - was it a specific person there who mentioned us? *Where was the sign located? *Which Paper Advertisement did you see? *Please Specify *What were you searching for when you found us online? *What is the name of the person that recommended us? *Have we assisted them with their Real Estate needs? *YesNoI'm not sureDo you know which property we assisted them with? *That's alright if you don't know. We just like to know who sent you our way.Which Agent has been assisting you? *Paul PowersBeth AbbottEmily AndrewsMason MeslerScott LeeDon WilkinsAlex MooreCaleb TrullOtherPerson's Name *What Agency are they with? *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 PROPERTYI/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: *1234========== ADULT # 1 ========== *FirstMiddleLastMarital Status *MarriedSingleSocial Security # *Birth Date *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Drivers License # & State *FirstLastAddress *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeCell Phone *Home Phone *Work Phone *Email Address *EmailConfirm Email========== ADULT # 1 - Employment *Employed **(If you are Self-Employed or Own your own business DO NOT choose this option)Self-Employed or Own My Own BusinessUnemployedDisabilityRetiredStay-at-Home CaregiverStudentOtherName of Employer *Do you do business as an individual or do you have a business name? *Individual - I use my Social Security # for my BusinessBusiness - I have a Federal ID # for my BusinessName of your Business *What service does your business offer? - What do you do? *Your Title or Position *Supervisor's Name *Employer's Phone Number *How long at your current job? *I just started a new job in the last 3 monthsLess than One Year1 Year +2 Years +3 Years +4 Years +5 Years +How long have you been Self-Employed or had your own Business? *I just started in the last 3 monthsLess than One Year1 Year +2 Years +3 Years +4 Years +5 Years +YOUR Monthly Income (DO NOT Include Spouse Income) *Please Specify Where Your Income Comes From *===== ADULT # 1 - REFERENCE - Someone Age 19 and Older - NOT LIVING WITH YOU *FirstLastRelation to you? *Cell Phone *Home Phone *Email Address *EmailConfirm EmailMailing Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip Code========== ADULT # 2 ========== *FirstMiddleLastMarital Status *MarriedSingleSocial Security # *Birth Date *Drivers License # & State *Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeCell Phone *Home Phone *Work Phone *Email Address *EmailConfirm Email========== ADULT # 2 - Employment *Employed **(If you are Self-Employed or Own your own business DO NOT choose this option)Self-Employed or Own My Own BusinessUnemployedDisabilityRetiredStay-at-Home CaregiverStudentOtherDo you do business as an individual or do you have a business name? *Individual - I use my Social Security # for my BusinessBusiness - I have a Federal ID # for my BusinessName of Employer *Name of your Business *Your Title or Position *What service does your business offer? - What do you do? *Supervisor's Name *Employer's Phone Number *How long at your current job? *I just started a new job in the last 3 monthsLess than One Year1 Year +2 Years +3 Years +4 Years +5 Years +Hoe long have you been Self-Employed or had your own Buiness? *I just started in the last 3 monthsLess than One Year1 Year +2 Years +3 Years +4 Years +5 Years +YOUR Monthly Income (DO NOT Include Spouse Income) *Please Specify Where Your Income Comes From *===== ADULT # 2 - REFERENCE - Someone Age 19 and Older - NOT LIVING WITH YOU *Relation to you? *Cell Phone *Home Phone *Email Address *EmailConfirm EmailMailing Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip Code========== ADULT # 3 ========== *Marital Status *MarriedSingleSocial Security # *Birth Date *Drivers LIcense # & State *FirstLastAddress *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeCell Phone *Home Phone *Work Phone *Email Address *EmailConfirm Email========== ADULT # 3 - Employment *Employed **(If you are Self-Employed or Own your own business DO NOT choose this option)Self-Employed or Own My Own BusinessUnemployedDisabilityRetiredStay-at-Home CaregiverStudentOtherDo you do business as an individual or do you have a business name? *Individual - I use my Social Security # for BusinessBusiness - I have a Federal ID # for my BusinessName of Employer *Name of your Business *What service does your business offer? - What do you do? *Your Title or Position *Supervisor's Name *Employer's Phone Number *How long at your current job? *I just started a new job in the last 3 monthsLess than One Year1 Year +2 Years +3 Years +4 Years +5 Years +How long have you been Self-Employed or had your own Business? *I just started in the last 3 monthsLess than One Year1 Year +2 Years +3 Years +4 Years +5 Years +YOUR Monthly Income (DO NOT Include Spouse Income) *Please Specify Where Your Income Comes From *===== ADULT # 3 - REFERENCE - Someone Age 19 and Older - NOT LIVING WITH YOU *FirstLastRelation to you? *Cell Phone *Home Phone *Email Address *EmailConfirm EmailMailing Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip Code========== ADULT # 4 ========== *FirstMiddleLastMarital Status *MarriedSingleSocial Security # *Birth Date *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Drivers License # & State *FirstLastAddress *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeCell Phone *Home Phone *Work Phone *Email Address *EmailConfirm Email========== ADULT # 4 - Employment *Employed **(If you are Self-Employed or Own your own business DO NOT choose this option)Self-Employed or Own My Own BusinessUnemployedDisabilityRetiredStay-at-Home CaregiverStudentOtherDo you do business as an individual or do you have a business name? *Individual - I use my Social Security # for my BusinessBusiness - I have a Federal ID # for my BusinessName of Employer *Name of your Business *What service does your business offer? - What do you do? *Your Title or Position *Supervisor's Name *Employer's Phone Number *How long at your current job? *I just started a new job in the last 3 monthsLess than One Year1 Year +2 Years +3 Years +4 Years +5 Years +How long have you been Self-Employed or had your own Business? *I just started in the last 3 monthsLess than One Year1 Year +2 Years +3 Years +4 Years +5 Years +YOUR Monthly Income (DO NOT Include Spouse Income) *Please Specity Where Your Income Comes From *===== ADULT # 4 - REFERENCE - Someone Age 19 and Older - NOT LIVING WITH YOU *Relation to you? *Cell Phone *Home Phone *Email Address *EmailConfirm EmailMailing Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip Code======== HOME INFO Your current living situation: *Own a HomeRentLive with FamilyOtherIf Other - Please Specify *Name of Landlord *Landlord's Phone Number *How long at your current address? *Less than One Year1 Year +2 Years +3 Years +4 Years +5 Years +Do you plan on putting a Home on the property? *No - Not at this timeYes - A Manufactured HomeYes - 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.Do you have a Manufactured Home already or are you in the process of purchasing it? *I already own itI am going to buy itWhich dealership are you shopping and who is your contact there? *Have you looked into a Land/Home Package? Does this sound like something you would like more info about? Speak to your Contact at the Dealership or call our Agent and they can go over the process with you.Have you chosen a builder? *NoYesSome of our Agents have a working relationship with a few local builders who have already built homes in a couple of our neighborhoods. Contact our Agent for a list of these builders.Who is it? *Info about home: *FirstLastIs the home in YOUR name?YesNoIf No - Then whose name is it in and what is their relation to you? *Owner's Phone *Is the home Paid Off? *YesNoWho is it financed with? *Finance Company Phone *Whose Name is it financed in and their relation to you? *======== ADDITIONAL OCCUPANTS - Children NUMBER OF CHILDREN YOUNGER THAN AGE 19 THAT WILL BE LIVING WITH YOU *0123456(REQUIRED WHETHER THEY LIVE WITH YOU PART-TIME OF FULL-TIME)Child # 1 *FirstLastChild # 2FirstLastChild # 3FirstLastChild # 4FirstLastChild # 5FirstLastChild # 6FirstLast======== PETS / ANIMALS PETS / ANIMALS *Yes - I Understand and AgreeWhether 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 *DogsCatsOtherNONE - I do not have pets at this timePlease Specify ALL Breeds *======== VEHICLES VEHICLES *No - I will not have any sort of large or commercial vehicle on the propertyYes - I Understand and AgreeOther 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, EtcPlease specify what type of large or commercial vehicle you will have your property. *======== BANKING INFORMATION Name of your Bank - City & State *FirstLastWhat kind of Bank Accounts do you have? - Please check all that apply. *CheckingSavingsOtherIf Other - Please Specify *Are you willing to let us draft your monthly payment each month? *Certainly - No ProblemPossibly - I'll Consider ItHard 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? *YesNoPersons Full Name *Why did he/she file Bankruptcy? *Date Filed *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Has he/she been Released from Bankruptcy? *YesNoGive specific date of Release *Chapter 7 or 13 ? *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? *YesNoPersons Full Name *Why? *How long ago was that? *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? *YesNoPersons Full Name *Why? *How long ago was that? *Have you, your spouse, significant other or a member of your family or household ever been adjudicated a sex offender? *YesNoPersons Full Name *Persons Relation To You *Please Explain *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)? *YesNoPersons Full Name *Persons Relation To You *Please Explain *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? *YesNoPersons Full Name *Persons Relation To You *Please Explain *CLAUSE A: *I have read Clause A - I Understand and AgreeI/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 # 1 - Signature * Clear Signature ADULT # 2 - Signature * Clear Signature ADULT # 3 - Signature * Clear Signature ADULT # 4 - Signature * Clear Signature Submit
