Customer Info Sheet for Land with Existing Home

Did you pay the APP Fee?? --> Application will NOT be processed until your App Fee is Paid. *

Application Date *

Which Property are you interested in? *

Have you seen this Property in person yet? *

I/We have only seen the ouside of the home
I/We have been shown the inside of the home
I/We have not seen this home in person yet

--->> 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 *

========== 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

Do you do business as an individual or do you have a business name? *

Individual - I use my Social Security # for my Business
Business - I have a Federal ID # for my Business

YOUR Monthly Income (DO NOT Include Spouse Income) *

===== ADULT # 1 - REFERENCE - Someone Age 19 and Older - NOT LIVING WITH YOU *

First

Last

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?

Will any residents be smoking inside the home? *

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

NUMBER OF CHILDREN YOUNGER THAN AGE 19 THAT WILL BE LIVING AT THE PROPERTY *

(REQUIRED WHETHER THEY LIVE WITH YOU PART-TIME OR 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 Leash Law and agree to abide by all City, County, State, Goverment 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 any HOA that may be active in my neighborhood; so my pets do not become a nuisance or danger to my neighbors.

FUTURE PETS / ANIMALS *

Yes - I Understand and Agree

I understand that if I acquire any pets in the future; whether caged, indoor or outdoor; I MUST contact the Seller/Landlord for approval and a Non-Refundable Pet Fee may be required at that time.

NUMBER OF PETS / ANIMALS THAT WILL BE LIVING AT THE PROPERTY *

(REGARDLESS IF PET IS CAGED, INDOOR OR OUTDOOR, TOTAL NUMBER OF PETS / ANIMALS MUST BE LISTED)

======== VEHICLE INFORMATION

How many licensed drivers in the home? *

How many Cars, Trucks, Motorcycles will be on the property? *

All vehicles on property must be in running order. No inoperable vehicles are allowed.

How many will be on the property: UTILITY / CARGO OR OTHER TYPES OF TRAILERS *

How many will be on the property: CAMPERS / RV'S *

Campers / RVs are NOT to be lived in while on the property. They may only be on the property as a stored vehicle, NOT for additional living quarters. You MAY NOT empty disposal tanks onto the property.

Campers / RVs are NOT to be lived in at all while on the property. They may only be on the property as a stored vehicle, NOT for additional living quarters. They MUST be stored in the Back Yard. You MAY NOT empty disposal tanks onto the property. *

I Understand and Agree to abide by the stipulations set out above concerning Campers / RVs

Please specify the TYPES of recreational vehicles and HOW MANY will be on the property: BOATS / JET SKIS / 4-WHEELERS / DIRT BIKES / BOONIE BIKES / GO-CARTS / GOLF CARTS, ETC *

Recreational Vehicles MAY NOT be used on the property, in the neighborhood or surrounding neighborhoods/properties, unless they are a properly registered road approved vehicle with a plate/tag from the DMV. This includes, but is not limited to: 4-Wheelers, dirt bikes, boonie bikes, go-carts, golf carts, etc. Any damages caused to the property or neighborhood will be the sole responsiblity of the Resident. Family, friends and guests of the Resident are held to these same standards, and the Resident will be held responsible for all family, friends and guests actions.

Regardless if I currently own any recreational vehicles or if in the future I acquire any recreational vehicles *

I Understand and Agree to abide by the stipulations set out above concerning Recreational Vehicles

LARGE OR COMMERCIAL 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 or commercial vehicle on the property, regardless if you are the owner or if it is a work vehicle owned by your employer; and regardless if it is short-term or long-term. ---- ** 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, but not limited to: 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? *

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 houshold 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 lived in a dwelling that had bedbugs? *

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, every 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 this above information to approve or disapprove m/our offer, including the right to make independent investigations of current or past employment history, credit references, public records and to run my/our credit. 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 and/or "eviction" at any time.

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.

CLAUSE D: *

I have read Clause D - I Understand and Agree

I/We, the undersigned, understand that the home I am applying for IS REQUIRED TO HAVE INSURANCE. ---- The Seller may let me acquire insurance on my own. I understand that I MUST list the Seller as the Lien Holder on my policy and I MUST keep the policy in full effect and not let it lapse at any time, or it will be grounds for Foreclosure. ----OR---- The Seller may acquire the policy and I will be required to make a monthly payment to the Seller for the cost of the Insurance. I understand that if I fail to make the Insurance payment to the Seller it will be grounds for Foreclosure.

CLAUSE E: *

I have read Clause E - I Understand and Agree

I/We, the undersigned, understand that ---- if this home is on City Sewage, the following information will not apply to me ---- but if the home is on a Septic System, the following information does apply to me. ---- This is a Single Family Residence, which means the Board of Health has approved the septic system for the specific number of bedrooms in the home. Having more than 5 people living in the home (whether short-term or long-term) can overload the system and cause damages. I understand that I will be responsible for the cost of repairs should this occur; as well as any other necessary repairs that may be required due to negligence, misuse, or the age of the system. I understand that I will need to get the tank pumped by a professional licensed company once every 3 years to maintain a healthy septic system.

ADULT # 1 - Signature *

Clear Signature

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Main Content

Customer Info Sheet for Land with Existing Home

======== HOME INFO

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

======== PETS / ANIMALS

======== VEHICLE INFORMATION

======== BANKING INFORMATION

======== LEGAL INFORMATION

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