Manufactured Home Insurance Application

Applicant Name:
Co-Applicant Name: leave this field blank if no Co-Applicant
Applicant Email:
Co-Applicant Email: leave this field blank if no Co-Applicant  
SSN: (000-55-5500)
Date of Birth: (mm/dd/yyyy)
Mailing Address:
Home Phone: (555-555-5555)
Work Phone: (555-555-5555)
Marital Status:

Co-Applicant - leave this field blank if no Co-Applicant
SSN: (000-55-5500)
Date of Birth: (mm/dd/yyyy)
Email Address:
Mailing Address:
Home Phone: (555-555-5555)
Work Phone: (555-555-5555)
Marital Status:

Mobile Home Park Name
Home Use
# of Units
Property Address
Lot Number
Year of Home (yyyy)

Purchase Price or Insured Amount Requested: $
Closing Date (mm/dd/yyyy)
Lien holder
Description Yes No
Permanent Foundation
Composite Roof
Wood, Masonite or Vinyl Siding
Supplemental heating Device (Woodstonve, Insert)
Is Home located within flood plain
Any property insurance losses within last 3 years
Any animals owned
Protective siding

Agreement to Provide Physical Damage Insurance
Property Insurance is required in connection with this loan. Key One Inc. IS the parent company of Key Insurance Agency. Please be aware that you are free to purchase insurance from any agent you prefer for the principle amount of the loan. Use of the service and purchase of any insurance products offered by Key Insurance Agency is at your sole discretion. The insurance policy you are required to purchase is to note the lender's interest with a loss payable clause in the lender's favor.

Authorization to Investigate Credit, Employment and Required Information
I authorize Key One Inc, any of it's subsidiaries , and any other Lender to whom Key One Inc or any of it's subsidiaries may seek to review this application for loan funding purposes to make or have any credit, employment or investigative inquiry that Key One Inc, it's subsidiaries, or any of its chosen Lenders may determine for the extension of credit or the collection of amounts owed by the Applicant and or Co-Applicant. Key One Inc. any of it's subsidiaries, and chosen Lenders, can furnish information concerning my account to consumer reporting agencies and others who may properly receive that information. If I/we ask, I/we will be informed whether or not a consumer report was requested. I/we will be informed of the name and address of the consumer reporting agency that furnished this report. I agree that this application remain the property of Key One Inc. and any of its subsidiaries and chosen lenders.

Key One Inc. and it'd subsidiaries Key One Mortgage, Inc. acts as a consultant only on Real Estate transactions for the benefit of the home purchaser and as a referral source to qualified brokers and Lenders.

By Submitting this application I agree to hold Key One Inc. and any of it's subsidiaries harmless if financing cannot be secured and the loan for which I am applying cannot be furnished for any reason.

I certify that no essential information has been concealed and that no misrepresentations have been made in this application.

Verification Code

Please enter the verification code; it is not case sensitive: