APPLICATION

(For purchase of mobile home)

Full Name:_________________________________________________________________________

(First) (FULL) Middle (Last)

Date of Birth: ____ / ____ / ____, Social Security Number: _____ / ____ / _______

Drivers License #: _________________________, State: _____, Length of time in Alaska: ________

Phone #’s: Home: __________________, Cell: __________________, Msg: __________________

# of Adults: _____, # of children: _____, (To Occupy the Home)

Current Address: _____________________________________________________ Zip:__________

# of Months: _____, Landlord’s Name: ________________________, Phone#:__________________

Previous Address: _____________________________________________________ Zip: __________

# of Months: _____, Landlord’s Name: ________________________, Phone#:__________________

Current Employer: ______________________________________ Phone #:_____________________

Address: _____________________________________________________, Zip: __________

Supervisor’s full Name:_________________ Length of Employment: ____________ (Yrs/Mos)

Title or Position: ________________________, Monthly Take-Home Income: $____________

Previous Employer: ______________________________________ Phone #:_____________________

Address: _____________________________________________________, Zip: __________

Supervisor’s full Name:_________________ Length of Employment: ____________ (Yrs/Mos)

Title or Position: ________________________, Monthly Take-Home Income: $____________

Self-Employed? ________

Business Name: _______________________________ Type of Business:________________________

Business Address: ____________________________________________________, Zip: __________

Monthly Take-Home Income: $_______________, How long have you been self-employed?_________

References (business): Name: ______________________________Phone #:____________

Name: ______________________________Phone #:____________

Other Income: ______________________, Amount: _______________, How often:____________

Do you qualify and expect an Alaska Permanent Fund (PFD) Check? ________

Name of Nearest Relative: ____________________________________, Phone #:_________________

Name of Nearest Relative: ____________________________________, Phone #:_________________

Do you use a mailing address? __________________________________________, Zip: __________

The undersigned applicant certifies that the information provided is accurate and true, and gives Triad Sales Company, Inc., their agents, and whomever they deem necessary authorization and authority to investigate the above information for accuracy. The undersigned applicant hereby authorizes Triad Sales Company, Inc. to obtain a credit report. Triad Sales Company, Inc. is further authorized to release a copy of the credit report to any prospective sellers, investors, and or any other person or company Triad Sales Company, Inc. deems necessary to pursue the purchase of a mobile home.

__________________________________________________________ Date: _____ / _____ / _____ Signature