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CREDIT REPORT INFORMATION FORM

Section 1

First Name*

MI

Last Name*

Suffix


Section 2 - Residence Address
Address 1*


Address 2


City*


State*


ZIP Code*


Is your mailing address the same as your residence address?*
Yes  No

If you answered "Yes," you may skip Section 3.

Section 3 - Mailing Address
Please note that this section is only required if you answered "Yes" to the question above.

Mailing Address 1*


Mailing Address 2


City*


State*


ZIP Code*


Section 4

E-Mail Address*


Confirm E-Mail Address*


Home Phone Number*
- -

Work / Other Phone
- -

Time of Day Contact Preference


Section 5 - Personal Information

Date of Birth (mm/dd/yyyy)*


Residency Status*


Will you have a co-applicant on this prequalification?*
Yes  No

By submitting this form for a pre-screen credit approval, you are giving Tri-County Homes, Inc., permission to
proceed with a credit background check for pre-qualification towards the purchase of a new home.

  

1-800-540-1295 Toll Free Line
Sales@tricountyhomes.com
info@tricountyhomes.com
(814) 226-6730 Professional Builder's Line
wholesalers@tricountyhomes.com
contractors@tricountyhomes.com
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Tri-County Homes, Inc. 22984 Route 66; Shippenville Pa. 16254 /(814) 226-5488 fax

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