EMG Credit Application
Please fill out all required fields.
Seller
Who was helping you?
*
Danny
Chris
Andrea
Jason
Information Regarding Applicant
Applicant will fill out required information here
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number
Date of Birth
*
-
Month
-
Day
Year
Date
Status
*
Married
Unmarried
Separated
Driver's License
*
Social Security Number / Federal Tax ID Number
*
Address (To Cover 5 Year History)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long have you lived here for?
*
Previous Address (To Cover 5 Year History)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long did you live here for?
Nearest Relative
*
First Name
Last Name
Relationship
*
Nearest Relative's Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Nearest Relative's Phone Number
*
Please enter a valid phone number.
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Applicant Employment History
Fill out employment history below
Job Title
*
Present Employer (To Cover 5 Year History)
*
How long have you worked here?
*
Employer Phone Number
*
Please enter a valid phone number.
Employer's Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Previous Job Title (To Cover 5 Year History)
Previous Employer (To Cover 5 Year History)
How long did you work here?
Previous Employer Phone Number
Please enter a valid phone number.
Previous Employer's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Applicant Income
Fill out your income below
Gross Monthly Income
*
Round to the nearest dollar
Mortgage or Rent
*
Round to the nearest dollar. If you are living with a relative or not paying rent, add a "0".
Additional Alimony Monthly Income (If applicable)
Round to the nearest dollar
Additional Alimony Income Arrangement
Court Order
Written Arrangement
Oral Understanding
Additional Child Support Monthly Income (If applicable)
Round to the nearest dollar
Additional Child Support Income Arrangement
Court Order
Written Arrangement
Oral Understanding
Additional Separated Maintenance Monthly Income (If applicable)
Round to the nearest dollar
Additional Separated Maintenance Income Arrangement
Court Order
Written Arrangement
Oral Understanding
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Information Regarding Spouse or Co-Applicant
Fill out spouse or co-applicant information below
Do you have a spouse or co-applicant?
*
Yes
No
Co-Applicant's Name
*
First Name
Last Name
Co-Applicant's Phone Number
*
Please enter a valid phone number
Co-Applicant's Date of Birth
*
-
Month
-
Day
Year
Date
Co-Applicant's Status
*
Married
Unmarried
Separated
Co-Applicant's Driver's License
*
Co-Applicants Social Security Number / Federal Tax ID Number
*
Co-Applicant's Address (To Cover 5 Year History)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long have you lived here for?
*
Co-Applicant's Previous Address (To Cover 5 Year History)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long did you live here for?
Co-Applicant's Nearest Relative
*
First Name
Last Name
Relationship
*
Co-Applicant's Nearest Relative's Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Co-Applicant's Nearest Relative's Phone Number
*
Please enter a valid phone number.
Co-Applicant's Gross Monthly Income
*
Round to the nearest dollar
Co-Applicant's Mortgage or Rent
*
Round to the nearest dollar. If you are living with a relative or not paying rent, add a "0".
Additional Alimony Monthly Income (If applicable)
Round to the nearest dollar
Additional Alimony Income Arrangement
Court Order
Written Arrangement
Oral Understanding
Additional Child Support Monthly Income (If applicable)
Round to the nearest dollar
Additional Child Support Income Arrangement
Court Order
Written Arrangement
Oral Understanding
Additional Separated Maintenance Monthly Income (If applicable)
Round to the nearest dollar
Additional Separated Maintenance Income Arrangement
Court Order
Written Arrangement
Oral Understanding
Co-Applicant Employment History
Fill out employment history below
Job Title
*
Present Employer (To Cover 5 Year History)
*
How long have you worked here?
*
Employer Phone Number
*
Please enter a valid phone number.
Employer's Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Previous Job Title (To Cover 5 Year History)
Previous Employer (To Cover 5 Year History)
How long did you work here?
Previous Employer Phone Number
Please enter a valid phone number.
Previous Employer's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Signature
I, the undersigned (1) make the above representations, which are certified correct, for the purpose of securing credit; (2) authorize financial institutions to obtain consumer credit reports on me periodically and to gather employment history as they consider necessary and appropriate; (3) authorize your affiliates to obtain consumer credit reports on me; (4) Unless the circle that follows is marked, I authorize the dealer and any assignee or other person to whom this application is submitted to share and use information about me, including information in my application, with other entities that are related to them by common ownership or affiliated by common control. If the circle is marked, I direct the dealer and any assignee or other person to whom this application is submitted not to give information to such entities (other than information on their own transactions and experiences.) (5) Understands that we or any financial institution to whom it is submitted will retain this application whether or not it is approved, and that it is the applicant’s responsibility to notify the creditor of any change of name, address or employment.
Applicant's Signature
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Co-Applicant's Signature
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