Thank you for visiting Southland Custom Homes website. By filling out and signing below, we can pre-qualify you for your Dream Home. Our pre-qualification form is a safe and secure form and is at no cost or obligation to you. Thanks for helping us help you.

* Denotes Required Fields
*First Name:
*Last Name:
E-mail Address:
*Mailing Address:
*City:
*State:
*Zip:
*Home Phone:
Work Phone:
Mobile Phone:
Best Contact Time:
AMPM
*Social Security #: - -
*Date of Birth:
*Monthly Income:

Would you like us to mail you our 2010 Home Plan Catalog
Yes No
Do you own land or are you buying land in Georgia?
YesNo
Please select the county in which you own land and/or which you intend to build:
Choose One:
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Choose Three:
Choose a Model Home Showroom Location
What prompted your visit to us? (Media Source)
Internet/Web Search
Georgia (EMC) Magazine
Saw Model Home or Showroom
Saw Yard Sign
Saw Bill Board
Yellow Pages
TV
Newspaper (which one)
Referred (by whom)
Other

Is there another person's income that you want included in this mortgage pre-qualification response (i.e. spouse, roommate, etc)?
YesNo
If you answered yes above please complete the following:
First Name:
Last Name:
Social Security #: - -
Date of Birth:
Monthly Income:
Your Comments or Questions?
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FAIR CREDIT REPORTING ACT NOTICE:

By submitting this form the client hereby authorizes the release to Southland Homes Corporation any and all information that they may require for the purpose of a credit transaction. Southland may reproduce this document as required. Any reproduction shall have the same effect as the original document. The client hereby gives Southland the authority to release credit information to an attorney, accountant, broker or any other third party as deemed necessary in the opinion of Southland for the purpose of expediting the handling of this application.

CLIENT AND SOUTHLAND AGREE THAT THIS IS NOT A CONTRACT FOR FINANCING OR CONSTRUCTION