Plantation Builders – Albany/Lee County, Georgia

*Borrower's Full Name:

Co-Borrower's Full Name:

*E-mail Address:

*Street Address:

*City:

*State:

*ZIP Code:

*Phone Number:

*Borrower's SSN:

Co-Borrower's SSN:

*Borrower's Date of Birth:

Co-Borrower's Date of Birth:

*Borrower's Employer:

*Number of Years:

Co-Borrower's Employer:

Number of Years:

*Borrower's Gross Monthly Income:

Other Income:

Source:

Co-Borrower's Gross Monthly Income:

Other Income:

Source:

Total of All Minimum Monthly Payments on Debts (car payments, credit cards, loans, etc.):

Cash Available for Initial Investment:

*I/we authorize Plantation Builders, Inc. to secure a retail credit report on me/us to determine my/our qualifications to buy.
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Date: