CLIENT INFORMATATION
CLIENT NAME
MAILING ADDRESS
CITY / STATE / ZIP
EMAIL ADDRESS
HOME PHONE CELL PHONE FAX
HOME PHONE* CELL PHONE FAX
EMERGENCY CONTACT NAME
EMERGENCY CONTACT PHONE NUMBER
MODULAR HOME INFORMATION
FLOOR PLAN INFORMATION (PLEASE SELECT ONE OF THE OPTIONS)
STANDARD MODEL CHOSEN - MINOR REVISIONS
STANDARD MODEL CHOSEN - MAJOR REVISIONS
STANDARD PLANS FROM OTHER THAN MODULAR HOME PLACE
ABLE TO EMAIL THE PLANS TO MODULAR HOME PLACE
MUST BE VIA GROUND SERVICE TO MODULAR HOME PLACE
CUSTOM DESIGN SERVICES WILL BE REQUIRED BY MODULAR HOME PLACE
EXPECTED DELIVERY DATE OF MODULAR HOME
THREE TO SIX MONTHS
SIX TO NINE MONTHS
NINE MONTHS OR MORE
TOTAL BUILDING BUDGET
CONSTRUCTION INFORMATION
WHO WILL BE ACTING AS THE GENERAL CONTRACTOR ON THIS PROJECT? - SELECT THE MOST APPROPIATE CHOICE.
THE CLIENT LISTED ABOVE WILL BE ACTING AS OWNER/BUILDER
BEING THE OWNER BUILDER I AM AWARE OF MY RESPONISIBILITIES AS OUTLINED AND DESCRIBED IN
THE “BUYERS RESPONSIBILITIES” AND “TERMS” AND CONDITIONS” OF MODULAR HOME PLACE FOR
THE PURCHASE OF A MODULA R HOME.
THE CLIENT WILL BE HIRING A GENERAL CONTRACTOR FOR THE PROJECT
GENERAL CONTRACTOR’S NAME
GENERAL CONTRACTOR’S PHONE NUMBER
BY HIRING A GENERAL CONTRACTOR BOTH THE CLIENT AND THE GENERAL CONTRACTOR
UNDERSTANDS THE RESPONISIBILITIES AS OUTLINED AND DESCRIBED IN THE “BUYERS
RESPONSIBILITIES” AND “TERMS AND CONDITIONS” OF MODULAR HOME PLACE FOR THE PURCHASE
OF A MODULA R HOME AND THAT WILL GENERAL CONTRACTOR WILL BE LISTED AS THE BUILDER
OF THIS PROJECT.
BUILDING LOT INFORMATION
BUILDING LOT ADDRESS
BUILDING LOT COUNTY
BUILDING LOT CITY / STATE / ZIP
COMMENTS / CONCERNS PERTAINING TO BUILDING LOT
PAYMENT METHOD
CASH - NO MORTGAGE WILL BE NECESSARY FOR THE PURCHASE.
MORTGAGE WILL BE USED (MORTGAGE INFORMATION MUST BE COMPLETED)
MORTGAGE INFORMATION
MORTGAGE PROVIDER’S NAME
PREAPPROVED AMOUNT
CLOSING DATE
Click on the button below to regester as a buyer to receive factory pricing.
Please use this form to register yourself as a future client of Modular Home Place. This form must be completed to receive factory pricing on any home. Thank you and we look forward to working with you in the future.
Buyer Registration
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Email us at: contactus@modularhomeplace.com
Modular Home Place, LLC
toll free: (866)-557-1984