Tri-County Homes - Credit Report

CREDIT REPORT INFORMATION FORM

Section 1

First Name*

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