First Name *

Last Name *

Phone *

Email *

Borrower / Entity 1 *

Borrower / Entity 2

Borrower / Entity 3

Additional Borrowers

Guarantor 1 Name *

Guarantor 1 Phone *

Guarantor 1 Email *

Guarantor 2 Name

Guarantor 2 Phone

Guarantor 2 Email

Guarantor 3 Name

Guarantor 3 Phone

Guarantor 3 Email

Additional Guarantors

Dealer or Wholesaler Name *

Dealer or Wholesaler Phone *

Dealer or Wholesaler Email *

Dealer or Wholesaler Physical Address *

Manufacturer / Make *

Model *

Year *

Sq Ft *

Beds *

Baths *

Form 500 - Manufactured Home Purchase Agreement (Click to Upload)

CLICK HERE TO UPLOAD

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

Transaction Type *

Manufactured Home Placement on Owned Land

Land Purchase + Manufactured Home Package

Purchase Price of Land *

Manufactured Home Cost *

Include home cost and delivery fee (not site work costs)

Total Upfront Deposit Due to Manufacturer *

How much does the Dealer / MF require up front to order the home?

Estimated Site Work Cost *

Include site work costs such as septic, HVAC, driveway, skirting, etc.

Total Project Cost *

Total requested loan amount (to cover all land, site, and home costs)

Estimated Completed Value *

Anticipated Closing Date *

Insurance Contact Name *

Insurance Contact Phone *

Insurance Contact Email *

Closing Attorney / Title Company Name *

Closing Attorney / Title Company Phone *

Closing Attorney / Title Company Email *

Have you been declared bankrupt within the past 7 years? *

Are you currently delinquent or in default on a State or Federal debt? *

Have you ever been convicted of a financial crime or felony? *

Are there any outstanding judgments against you? *

Are you a party to a lawsuit in which you could have personal financial liability? *

Have you been directly or indirectly obligated on any loan that resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment? *

If any of the answers above were Yes, please explain.

By checking this box, I consent to receive phone, text, and email communication from Rehab Wallet.

I certify that all statements made in this application are true to the best of my knowledge and belief. I understand that the lender may verify the information contained in this application through third-party sources.