Harmony Homes of Illinois

There is no Place Like Home

100 Wesley Drive #11, East Alton, IL 62024
Phone: (618) 259-7888
Email: harmonyhomesil@aol.com

Application

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*First Name:
*Last Name:
*Social Security Number:
*Date of Birth: mm/dd/yyyy
*Marital Status:
*Sex:
*Race:
*Ethnicity:
*Address:
*City:
State:
*Zip Code:
*Phone Number: (xxx) xxx-xxxx
*Work Number: (xxx) xxx-xxxx
*Email:
Employer Name:
Yearly Income:

Co-Applicant Information

First Name:
Last Name:
Social Security Number:
Date of Birth: mm/dd/yyyy
Marital Status:
Sex:
Race:
Ethnicity:
Address:
City:
State:
Zip Code:
Phone Number: (xxx) xxx-xxxx
Work Number: (xxx) xxx-xxxx
Email:
Employer Name:
Yearly Income:
Best Time to Call:
 
1. I'm interested in: Purchasing a Home
Purchasing a home and land
Refinancing existing account
 
2. Model Number of Home interested in:
 
3. I'm currently a: Renter
Home Owner
Living with Family
 
4. How much is montly payment: $
 
5. The Home is used for: Primary Residence
Vacation Home
Investment Property
 
6. The Home is a: Singlewide
Doublewide
Modular
 
7. The Home is/will be on: MH Landlease Park/Community
Leased, Family or Friend's Land
Own Land, but don't need account for land
Own land, Need land/home financing
 
8. Check which of the following do you need: Piers
Pad
Footing
Block Wall Underpinning
Basement
Electric Service
Water Tap
Sewer Tap
Well
Private Sewer Disposal
 
9. Are you trading your existing home? No
Yes
 
10. Year house was built:
 
11. Please use the space provided below to list your largest monthly payment and approx. account balance:
 
12. Contact me by:
 
I do certify:
 
 
Comments, Concerns, Special Requests:
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