Application

    MHD Empire's Secure Online Credit Application

    Applicant Credit Information Note: If married, the spouse is not required to the joint applicant Please advise whether credit references and/or credit history should be investigated under another name. It is a crime to intentionally falsify information on this application.

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    Credit Application Form

    *Indicates a required field

    Basic Information:

    Primary ResidenceNon-Primary Residence / SeasonalInvestment / Rental

    Purchase Home OnlyPurchase Home and LandRefinance

    YesNo

    UnmarriedMarriedSeparated

    How long at present address (Since when?)

    HomeownerRenterLiving with ParentOther

    YesNo

    HourlySalary

    WeeklyBi-weeklyMonthly

    Applicant's Other Income

    Income for SSI, retirement, disability, alimony, child support, or other separate maintenance agreement need not be disclosed if you do not wish to have it considered as a basis for undertaking or repaying this debt.

    Applicant's Debts/Obligations

    Additional Questions:


    Demographic Information - this section asks about your ethnicity, sex, and race

    The purpose of collecting this information is to help ensure that all applicants are treated fairly and that the housing needs of communities and neighborhoods are being fulfilled. For residential mortgage lending, Federal law requires that we ask applicants for their demographic information (ethnicity, race, and sex) in order to monitor our compliance with equal credit opportunity, fair housing, and home mortgage disclosure laws. You are not required to provide this information, but are encouraged to do so. The law provides that we may not discriminate on the basis of this information, or on whether you choose to provide it. However, if you choose not to provide the information and you have made this application in person, Federal regulations require us to note your ethnicity, race, and sex on the basis of visual observation or surname. The law also provides that we may not discriminate on the basis of age or marital status information you provide in this application.

    Instructions: You may select one or more designations for "Ethnicity" and one or more designations for "Race." If you do not wish to provide some or all of this information, select the applicable check box.

    Hispanic or LatinoNot Hispanic or LatinoI do not wish to provide this information

    MexicanPuerto RicanCubanOther Hispanic or Latino

    American Indian or Alaskan NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhiteI do not wish to provide this information

    Asian IndianChineseFilipinoJapaneseKoreanVietnameseOther Asian

    Native HawaiianSamoanGuamanian or ChamorroOther Pacific Islander

    MaleFemaleI do not wish to provide this information

    Sales & Transaction Information:

    Home OnlyLand/HomeLand-In-Lieu

    Manufactured Home Information:

    NewUsed

    Primary ResidenceSecondary Residence / Seasonal

    Owned Property with No LienOwned Property Contract / Mortgage Trust DeedLeasedFamily LandCommunityROC(Resident Owed Community)Reservation

    YesNo

    YesNo

    Certify and Sign

    I/We certify that the information stated is complete and accurate, and has been furnished by me (us) knowing that you intend to rely on it in considering my (our) application. I (we) understand that you may request a consumer report in connection with this application and for the purpose of updating, renewing or extending further credit, and, if I (we) ask, I (we) will be informed whether or not such a report was requested (and, if so, the name and address of the consumer reporting agency that furnished the report). I (we) agree that this application remains the property of MHD Empire Service Corp. whether or not a loan is granted. I (we) also authorize you to check my (our) employment/income history and to exchange account and credit information about me (us) with anyone you may ask. To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account. When you open an account, we will ask for your name, address, date of birth and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying information. It is a crime to intentionally falsify information on this application.

    Authorization to Provide and Release Information (OPTIONAL)

    Dear MHD Empire Service Corp Customer(s):
    In order for MHD Empire Service Corp. to discuss your credit application/manufactured home loan with a third party, we must obtain a letter of authorization form signed by all applicants. Please review the form below and complete the following:

    • Specify the name(s), address, phone number, and relationship of the person you are authorizing MHD Empire Service Corp. to verbally discuss information with regarding your credit application/manufactured home loan.
    • MHD Empire Service Corp will need the signature of everyone who is on the credit application/manufactured home loan paperwork.
    • Please make sure that the form is dated

    Letter of Authorization

    I/We hereby authorize MHD Empire Service Corp. to discuss my/our credit application and/or manufactured home loan with the individual(s) below:


    I/We hereby release MHD Empire Service Corp. its employees, officers, agents, and directors from any claim(s) that might arise in connecton with this authorization.

    YOU MAY REVOKE THIS AUTHORIZATION AT ANY TIME BY PROVIDING WRITTEN NOTICE.

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    Contact

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    GET IN TOUCH

    +1 866 870 2612
    mhdemp@haylor.com
    300 South State St, Suite 1000
    Syracuse, NY 13202
    Company NMLS #51371