55013 Dealer/contractor Application

OMB Approval No. 2502-0328
(exp. 08/31/2009)

U.S. Department of Housing
and Urban Development
Office of Housing
Federal Housing Commissioner

Dealer/Contractor Application
Title I Property Improvement and
Manufactured Home Loans

Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This agency may not collect
this information, and you are not required to complete this form, unless it displays a currently valid OMB control number.
This information is being collected to permit more efficient risk management of the Title I loan portfolio as well as facilitate claims processing for loan
defaults. The information provides a more comprehensive basis for evaluating Title I lender underwriting practices and thereby improving risk management
of the loan portfolio and also enhances management’s ability to determine appropriate policy changes affecting the Title I portfolio as a whole. Responses
are required in order to obtain benefits. No assurance of confidentiality is provided.
Privacy Act Statement: The Department of Housing and Urban Development (HUD) is authorized to collect this information by Title I, section 2 of the
National Housing Act (12 U.S.C. 1703), and the Housing and Community Development Act of 1987 (42 U.S.C. 3543). The information you provide will
be used to assist HUD in accounting for and monitoring the use of Title I funds. HUD may conduct a computer match to verify the information you provide.
This information may be released to appropriate Federal, State, and local agencies, when relevant, and to civil, criminal, or regulatory investigators or
prosecutors. However, the information will not be otherwise disclosed or released outside of HUD except as required or permitted by law. You must provide
all the information requested, including the SSNs. Failure to provide any of the requested information may result in delay or rejection of your application.
Send this completed form to each lending institution with which you expect to do Title I business.

This application is submitted for approval
in accordance with the regulations under
Title I of the National Housing Act.

To (Name of Lending Institution)

Dealer's Trade Name

Date Established

Type of Business

Telephone Number

Present Address

Yrs. at Present Address

Previous Address

Yrs. at Previous Address

Ownership

No. of Salespersons

Individual

Partnership

Corporation

Attach a separate sheet with name, address, Social Security
Number and 5-year employment history for each salesperson.

Employment History of Owners, Principals and Officers. Provide five-year history for all owners, principals and/or officers. Attach separate sheets if necessary.
Name

Social Security Number

Names & Addresses of Employers for past 5 Years

Name

Title

Type of Business

Dates of Employment

Social Security Number

Names & Addresses of Employers for past 5 Years

Name

Title

Type of Business

Dates of Employment

Social Security Number

Names & Addresses of Employers for past 5 Years

Name

Title

Type of Business

Dates of Employment

Social Security Number

Names &d Addresses of Employers for past 5 Years

Title

Type of Business

Dates of Employment

Lending Institutions Financing Inventory and/or Purchasing Contracts Presently or Previously.
Name

Previous editions are obsolete

Address

Page 1 of 2

Floor
Plan

Discount

Present Previous

ref. Handbook 1060.2

Dates (From/To)

form HUD-55013 (4/95Rev1)

Products or Types of Work to be Financed. (Attach descriptive literature.)
Trade Name

Manufacturer’s Name

Address

Trade References. (Attach any warranty or guaranty given buyers.)
Name

Sales Area

No. of Branch Offices

Address

Additional Information

Name

Sales Area

Address

Additional Information

Name

Sales Area

Address

Additional Information

No. of Branch Offices

No. of Branch Offices

I (we) hereby understand that I (we) am (are) fully responsible for the Title I activity of all my (our) sales personnel, that ethical and
proper selling practices will be followed, and that immediate attention will be given to all complaints involving materials, workmanship
or sales representations. If complaints are not resolved to the satisfaction of the borrower, lender and HUD, the contract will be
repurchased by the Dealership or its successors or assigns. I (we) hereby certify that the above statements are true. I (we) understand
this application remains the property of the lending institution, and if requested, will be furnished to the Department of Housing and
Urban Development (HUD). I (we) also agree to give written notice within 30 days of any material change in trade name, places of
business, type of ownership, type of business, or individuals who control or manage the business.
Authorized Official of Dealership (Name, Signature, & Date)

X
Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
For Use of Title I Lender

Commercial Credit Report on Firm
Consumer Credit Reports on Principals
Current Financial Statement
Net Worth Checked

References Checked
Previous Lenders Checked
Firm, all Principals and Salespersons
checked against precautionary list

Copy of Contract Sales Agreement Received
Sales Literature Received
Applicant given copy of Dealer Guide

Place of Business Inspected by (signature & title)

Date

Remarks

This Dealer/Contractor Application has been approved after such investigation as we consider necessary to establish that the applicant is reliable, financially
responsible and qualified to deliver and install satisfactorily the work or product to be financed and to provide proper service to the customer.
Approved by (signature & title)

Previous editions are obsolete

Date

Page 2 of 2

ref. Handbook 1060.2

form HUD-55013 (4/95Rev1)