Check Appropriate Box: ⬜ Applying for Individual Credit ⬜ Applying for Joint Credit
NOTE: Applicant, if married, may apply for a separate account
|
Seller
|
Financing Services
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Products
|
Date
|
Amount Requested $______________ |
Applicant Information
EMAIL ADDRESS____________________________________
CELL PHONE #______________________________________
HOME PHONE #_____________________________________
DRIVER”S LICENSE #_________________________________
DATE OF BIRTH______________________________________
LAST NAME (PRINT) _______________ FIRST NAME ________________________ MIDDLE INITIAL_____
SOCIAL SECURITY NUMBER__________________________
ADDRESS___________________________ CITY _______________STATE______ ZIP________
HOW LONG?
_____ YEARS ______ MONTHS
PREVIOUS ADDRESS__________________ CITY_______________ STATE______ ZIP_______
HOW LONG?
_____ YEARS ______ MONTHS
PREVIOUS ADDRESS__________________ CITY_______________ STATE_______ ZIP_______
HOW LONG?
_____ YEARS ______ MONTHS
PRESENT EMPLOYER_________________________
OCCUPATION___________________ HOW LONG EMPLOYED?____________________
_____ YEARS ______ MONTHS
PRESENT EMPLOYER ADDRESS___________________________________
CITY_________________ STATE________ ZIP__________ WORK PHONE #__________________
PREVIOUS EMPLOYMENT ________________________________________
ADDRESS____________________ CITY_________ STATE______ ZIP_______ PHONE_____________
HOW LONG EMPLOYED?
_____ YEARS
_____MONTHS
PREVIOUS EMPLOYMENT ________________________________________
ADDRESS____________________ CITY_________ STATE______ ZIP_______ PHONE_____________
HOW LONG EMPLOYED?
_____ YEARS
_____MONTHS
NEAREST RELATIVE NOT LIVING WITH APPLICANT_________________________
ADDRESS______________________ CITY___________ STATE_____ ZIP________ PHONE___________
RELATIONSHIP____________________
Income:
| Applicant's gross monthly income from employment: | $ |
| Amount of other monthly income and source(s): | $ |
| Total Monthly Income | $ |
Co-Applicant Information:
EMAIL ADDRESS____________________________
CELL PHONE #______________________
HOME PHONE #_____________________
DRIVER”S LICENSE #_____________________
DATE OF BIRTH__________________________
LAST NAME (PRINT)___________________ FIRST NAME__________________ MIDDLE INITIAL________
SOCIAL SECURITY NUMBER________________________
ADDRESS________________________________________
CITY__________________________ STATE_________ ZIP____________
HOW LONG?
_____ YEARS ______ MONTHS
PREVIOUS ADDRESS____________________________________
CITY____________________________ STATE_________ ZIP__________
HOW LONG?
_____ YEARS ______ MONTHS
PREVIOUS ADDRESS____________________________________
CITY____________________________ STATE_________ ZIP__________
HOW LONG?
_____ YEARS ______ MONTHS
PREVIOUS ADDRESS____________________________________
CITY____________________________ STATE_________ ZIP__________
HOW LONG?
_____ YEARS ______ MONTHS
PRESENT EMPLOYER________________________________
ADDRESS__________________________________________
CITY_________________________ STATE_________ ZIP_____________
WORK PHONE #______________________________
PREVIOUS EMPLOYMENT__________________________________
ADDRESS_______________________________________
CITY_______________________ STATE________ ZIP______________
PHONE________________________
HOW LONG EMPLOYED?
_____ YEARS
_____MONTHS
PREVIOUS EMPLOYMENT__________________________________
ADDRESS_______________________________________
CITY_______________________ STATE________ ZIP______________
PHONE________________________
HOW LONG EMPLOYED?
_____ YEARS
_____MONTHS
NEAREST RELATIVE NOT LIVING WITH APPLICANT_____________________________
ADDRESS_____________________________
CITY____________________ STATE______ ZIP_________ PHONE_____________________
RELATIONSHIP_____________________________
Income:
| Joint applicant's gross monthly income from employment: | $ |
| Amount of other monthly income and source(s): | $ |
| Total Income: | $ |
| Combined Total Monthly Income | $ |
Additional Information:
LANDLORD OR MORTGAGE HOLDER (APPLICANT)__________________________________⬜ OWN ⬜ RENT
ADDRESS _____________________________ ACCOUNT #___________________________
MORTGAGE BALANCE______________________________________
PAYMENT OR RENT $__________________________
LANDLORD OR MORTGAGE HOLDER (CO-APPLICANT)_______________________________⬜ OWN ⬜ RENT
ADDRESS _____________________________ ACCOUNT #___________________________
MORTGAGE BALANCE______________________________________
PAYMENT OR RENT $__________________________
DATE HOME PURCHASED_________________________ AGE OF HOME______________________
PRICE PAID FOR HOME_____________________________
MARKET VALUE______________________________
2ND MORTGAGE AMOUNT_________________________ PAYMENT $__________________________
BANK REFERENCE____________________________________
BRANCH___________________________ ACCOUNT #_____________________________
HAVE YOU HAD ANY PROPERTY REPOSSESSED IN THE LAST 7 YEARS?
⬜ YES ⬜ NO
HAVE YOU EVER FILED FOR BANKRUPTCY, OR IS A BANKRUPT
PROCEEDING IN PROGRESS OR EXPECTED? ⬜ YES ⬜ NO
PERSONAL FRIENDS KNOWN OVER ONE YEAR
NAME____________________________ADDRESS___________________ CITY___________________
STATE_______ ZIP___________ PHONE#___________________________________
NAME____________________________ADDRESS___________________ CITY___________________
STATE_______ ZIP___________ PHONE#___________________________________
By signing this application, I grant permission to the Dealer and any Finance Company, Bank, or other
Financial Institution to which the Dealer forwards my application ("you") to scrutinize my credit and
employment records, acquire credit reports, and disclose details about my credit history in accordance
with legal provisions. In the event of an account establishment, I authorize you to procure credit reports
for the purpose of assessing or initiating collection procedures on the account, or for other valid purposes
associated with the account.
I attest that I have perused and consent to the terms outlined in this application, and I affirm that the
information provided is comprehensive and accurate.
X________________________________________ X_______________________________________
Applicant Co-Applicant