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In accordance with my (our) credit application dated loan pursuant to the provisions of Title I of the National Housing Act: CHECK HERE IF LOAN IS TO PAY FOR COST OF MATERIALS AND INSTALLATION. I (we) hereby certify that all articles and materials have been furnished and installed and the work satisfactorily completed on premises indicated in my (our) credit application.

CHECK HERE IF LOAN COVERS ONLY THE PURCHASE OF MATERIALS.

I (we) hereby acknowledge receipt in satisfactory condition of the materials described in my (our) credit application.

I (we) certify that I (we) have not been given or promised a cash payment or rebate nor has it been represented to me (us) that I (we) will receive a cash bonus or commission on future sales as an inducement for the consummation of this transaction. I (we) understand that the selection of the dealer and the acceptance of the materials used and the work performed is my (our) responsibility and that neither the FHA nor the financial institution guarantees the material or workmanship or inspects the work performed.

NOTICE TO BORROWER

Do not sign this certificate until you are satisfied that the dealer has carried out his obligations to you and that the work or the materials have been satisfactorily completed or delivered.

Date

Borrower Signature

Borrower Signature

(READ BEFORE SIGNING)

For the purpose of inducing the payment of proceeds of this loan and the insurance thereof by the FHA the undersigned certifies and warrants that:

(1) The above work or materials constitute the entire consideration for which this loan is made, (2) a copy of the contract or sales agreement has been delivered to the borrower and the above financial institution, (3) this contract contains the whole agreement with the borrower, (4) the borrower has not been given or promised a cash payment or rebate nor has it been represented to the borrower that he will receive a cash bonus or commission on future sales as an inducement for the consummation of this transaction, (5) the work has been satisfactorily completed or materials delivered, (6) the above certificate was signed by the borrower after such completion or delivery, (7) the signatures hereon and on the note are genuine, (8) all bills for labor or materials have been or will be paid. If any of the above representations prove incorrect, the undersigned agrees to promptly repurchase the note from the financial institution or from the FHA as the case may be.

DEALER SIGN HERE

Date

By

(Name of dealer)

(Signature)

WARNING: Any person who knowingly makes a false statement or a misrepresentation in this certificate shall be subject to a fine of not more than $5,000 or to imprisonment for not more than 2 years, or both, under provisions of the United States Criminal Code.

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The following information is furnished for the purpose of inducing you to approve my (our) application as a dealer, pursuant to the provisions of Regulation VIII, Section 1 (a) issued by the Federal Housing Commissioner under the authority contained in Title I of the National Housing Act.

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Trade references (name suppliers of major products financed under Title I FHA):

(Home address)

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(Address)

From...

to

(year)

(year)

From..

to

(year)

(year)

(Name) If paper to be financed represents the sale of a specialty product, indicate trade name and manufacturer

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I (we) understand that I (we) are fully responsible for the Title I activity of all 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.

I (we) certify that the statements are true. I (we) understand this application shall remain the property of the financial institution to which it is submitted and, if requested, a copy may be furnished to the Federal Housing Administration.

Firm....
Name

(Title)

WARNING: Any person who knowingly makes a false statement or a misrepresentation in this certificate shall be subject to a fine of not more than $5,000 or to imprisonment for not more than 2 years, or both, under provisions of the United States Criminal Code.

THIS SPACE FOR USE OF DEALER IN SUPPLYING ADDITIONAL INFORMATION

THIS SPACE FOR USE OF INSURED INSTITUTION

Dealer given copy of dealer guide.

Firm and all principals checked against precautionary measures list.

References checked.

Credit report dated

Previous lenders checked.

Place of business inspected by

Date

Remarks

attached.

The dealer whose application appears on the reverse hereof has been approved after such investigation as we consider necessary to establish that the dealer is reliable, financially responsible and qualified to perform satisfactorily the work to be financed and to extend proper service to the customer.

Dealer approved

By:

195.

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FHA does not furnish this form. It may be reproduced with such modifications necessary to meet any special needs of the financial institution.

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