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        Quick Credit Application
 

Start Shopping online and get pre-qualified over the Internet!

To begin the pre-qualification process, simply fill out the on-line application below. A representative will contact you with your qualifying results and help you find the home of your Dreams. Again, all information will remain confidential.

601-631-0327  
Toll Free 1-800-274-0763
601-631-0291
kelleycolemansmith@yahoo.com

(Note: All fields are required unless indicated )
Applicant:
First Name: 
Last Name: 
Address: 
City:  State: Zip:
Email: 
Currently I: 
Home Phone:  -
Work Phone (optional):  -
Cell Phone (optional):  -
Birth Date:  / / (MM/DD/YYYY)
Social Security:  - -
Marital Status: 
Place of Employment: 
Length of Employment:  Years Months
Monthly pay before taxes:  $
Is there a co-applicant?    Yes  No 
Planned monthly payment:  $
Do you own land? 
Land in place of cash down? 
Available down payment  $
Multi or single section home? 
Best time to call: 
Notes (optional):
DATA-COLLECTION FORM
INFORMATION FOR GOVERNMENTAL MONITORING PURPOSES

NOTICE: The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant's income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The Federal Agency that administers compliance with this law concerning this creditor is the Federal Trade Commission, Washington, D.C. 20580.

INFORMATION FOR GOVERNMENT MONITORING PURPOSES 

The following information is requested by the federal government for certain types of loans related to a dwelling in order to monitor the lender's compliance with equal credit opportunity, fair housing, and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. You may select one or more designations for “Race.” The law provides that a lender may not discriminate on the basis of this information, or on whether you choose to furnish it. However, if you choose not to furnish the information and you have made this application in person, under federal regulations the lender is required to note ethnicity, race, and sex on the basis of visual observation or surname. If you do not wish to furnish this information, please check below:


Applicant:

(1) I do not wish to furnish this information

(2) Ethnicity:

      (a) Hispanic or Latino
      (b) Not Hispanic or Latino

(3) Race:

      (a) American Indian or Alaska Native
      (b) Asian
      (c) Black or African American
      (d) Native Hawaiian or Other Pacific Islander
      (e) White

(4) Gender:

      (a) Female
      (b) Male


By typing your name below you give your permission to any financial institution listed above to investigate your credit and employment history and you authorize release of all credit-related information to those institutions. If your application is declined, you will be notified within 30 days. This information may be shared with affiliated entities in order to provide you products and/or services.


Applicant Signature
   
   Co-Applicant Signature