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First Name:
Last Name:

Address:
City:
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Zip:
Home Phone:

Work Phone:

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Best Time to Call:
1. I am interested in: (check one)
    Purchasing a Home
    Purchasing a Home and Land
    Refinancing Exisiting Loan(s)
2. The Home is used for: (check one)
    Primary Residence
    Vacation Home
    Investment Property
3. The Home is a: (check one)
    Singlewide
    Doublewide
    Site Built Home
4. The Home is/will be on:
    MH Landlease Park/Community
    Leased, Family or Friends Land
    Own Land, But dont need loan for land
    Own Land, Need land/home financing
5. Year Home was Built:
6. My Credit Standing:
    Never had credit problems
    No credit problems for past 2 years
    No credit problems for one full year
    Minor Credit Problems
    Major Credit Problems
7. Contact me by:
8. Comments, concerns, or special requests:

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Park Models Direct does not lend money directly or indirectly to borrowers, but we will attempt to work with outside brokers and lenders selected, without influence from us, by our customers.

Park Models Direct does not endorse or promote specific third party lenders, however upon request, the information collected above may be shared, non-parsed, with interested outside lenders.