Community Application Form - Heritage Homes & Realty

Community Name*
Name*
First Middle Last
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Time At Current Address
Home Phone*
Birthdate*
Date Format: MM slash DD slash YYYY
Marital Status
- Married
- Divorced
- Separated
- Unmarried
Current Home Type
- Home Owner
- Renter
- Other
Current Monthly Housing Cost
Landlord's Name
First Last
Landlord's Phone
Employer Name
Salary (monthly gross)
Hire Date
Date Format: MM slash DD slash YYYY
Work Phone
Other Income:
You do not have to reveal information about alimony, child support or separate maintenance incomes unless you want to have them considered as a basis for qualification of residence. If you wish to have such income considered, please list source and monthly amount.
Do you have a co-applicant:

Co-Applicant Information (optional)
Name*
First Middle Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Time At Current Address
Home Phone*
Birthdate*
Date Format: MM slash DD slash YYYY
Marital Status
- Married
- Divorced
- Separated
- Unmarried
Current Home Type
- Home Owner
- Renter
- Other
Current Monthly Housing Cost
Landlord's Name
First Last
Landlord's Phone
Employer Name
Salary (monthly gross)
Hire Date
Date Format: MM slash DD slash YYYY
Work Phone
Other Income:
You do not have to reveal information about alimony, child support or separate maintenance incomes unless you want to have them considered as a basis for qualification of residence. If you wish to have such income considered, please list source and monthly amount.

Other People/Pets
Information about additional people residing in your home.
Name Relationship Data of Birth (MM/DD/YYY)
Note: there are no pets allowed at Park Lawn Estates.
Do you own a boat, trailer or other vehicle.
- Yes
- No
Please describe
The lease allows for two vehicles per homesite. Boats, campers, etc. must be stored outside the community or in a designated area.
Information about pets
Heritage Village: 1 dog (20lbs or Less) or 2 indoor cats
Park Lawn Estates: No pets
Bostwick Valley: No dogs, 2 indoor cats only
Creekside: 1 dog (25lbs or less) or 2 indoor cats
Type & Breed Size
Emergency Contact Person
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone

Information About Your Manufactured Home Purchase
Existing Home in Our Community
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Purchase Price
Bringing a Home into our community
New Home Size & Year
Dealer Selling the Home
Pre-Owned Home Size & Year
*all pre-owned homes must be inspected before approval can be given and must meet the community requirements. (contact us for details)
Make
ID#
Model Year
Size
Type of Siding
Type of Roof
Date of Home Purchase
Date Format: MM slash DD slash YYYY
Total Purchase Price($)
Listing Agent
Occupancy Date
Date Format: MM slash DD slash YYYY
Site Number
Seller
Contact Person
Financed By
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Amount of Loan
Monthly Payment

References
1. Have you, or co-applicant if applicable, declared bankruptcy within the past 10 years? Who? Where? When?*
2. Have you, or co-applicant if applicable, had any judgements, repossessions, garnishments, or legal proceedings filed against you within the past 7 years?*
3. Have you, or co-applicant if applicable, ever obtained credit under any other name(s)? List name(s) used:*
4. Have you or any other proposed occupants of the site been convicted of a crime? If yes, explain*
5. Have you or any other proposed occupants of the site been evicted? If yes, explain.*
6. Have you or any other proposed occupant of the site ever been convicted of the illegal manufacture or distribution of a controlled substance? If yes, explain.*
7. Are you or any other proposed occupant of the site, a current illegal user or addict of a controlled substance? If yes, explain.*
8. Have your or any proposed occupant ever been convicted of a sex related crime or required to register as a sex offender? If yes, explain.*

Submit
For the purpose of obtaining the credit requested, I represent that the information provided above is true, complete and correct. I understand that if my application is approved, any false statements on or in connection with this application may result in eviction. You are hereby authorized to verify this information and obtain additional information concerning my credit, employment history or any other information, including without limitations, consumer credit reports, to furnish such information and any other credit experience with me to others, and to answer any questions about my credit experience and other financial relationships with you. If I am required to provide a security deposit, I understand that such deposit will be returned if my application is not approved. I have read, understand and agree to comply with the Rules and Regulations of the Community now in effect, including any future amendments or postings thereto. By submitting this Application, I acknowledge that I have been provided with the opportunity to review the Privacy Policy below and understand and accept the statements contained therein. I understand that I can request a hard copy of the Privacy Policy by contacting you at 250 Scott Dr, Onalaska, WI 54650.
Privacy Policy*
We collect nonpublic personal information about you from the following sources: 1) information we receive from you on your applications or other forms; 2) information about your transactions with us, our Affiliates, or others; and 3) information we receive from a consumer reporting agency. We do not disclose any nonpublic personal information about our residents or former residents to anyone except as permitted by law. We restrict access to nonpublic personal information about residents and former residents to those employees who need to know that information to provide products or services to you. We maintain physical, electronic, and procedural safeguards that comply with federal standards to guard your nonpublic personal information. We will contact you via phone for your Social Security Number to complete this application. For security reasons we do not accept this information online.
- I Agree
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Step 1 of 6

Co-Applicant Information (optional)

Other People/Pets

Emergency Contact Person

Information About Your Manufactured Home Purchase

Bringing a Home into our community

References

Submit

Office Hours

Links of Interest

Name	Relationship	Data of Birth (MM/DD/YYY)

Type & Breed	Size