APPLICATION

CREDIT APPLICATION

APPLICANT'S INFORMATION:
YOUR MARITAL STATUS
MARRIEDUNMARRIEDSEPARATED
NAME
SSN#
DATE OF BIRTH

MonthDayYear
Date
Address

ADDRESS

Street Address Line 2

CITY & STATEState / Province

ZIP
HOW LONG
CITY & STATE

RENTOWN
YEARS
HOW MUCH$
WHEN DUE
PHONE
DIRECTIONS TO RESIDENCE FROM THIS LOCATION
LANDLORD/OR MORTGAGE HOLDER
LANDLORD ADDRESS
LANDLORD PHONE#
EMPLOYER
EMPLOYER ADDRESS
EMPLOYER PHONE
NET PAY
PAY SCHEDULE

WEEKLYBI-WEEKLYBI-MONTHLYMONTHLY
HOW LONG
YEARS
MONTHS
SUPERVISOR
YOUR POSITION
CO WORKER
NO. OF DEPENDENTS
AGES
NAMES
SCHOOL DISTRICT
DO YOU RECEIVE OR PAY CHILD SUPPORT?

YESNO
IF YES, GO TO CHILD SUPPORT PAGE 2, SECTION A
CHECKING ACCT#
BANK
BRANCH
AVE. BAL.
PARENTS NAME
ADDRESS
PHONE
TOTAL OF MONTHLY PAYMENTS (RENTS, LOANS, CREDIT CARDS, UTILITIES, ETC.)
TWO BEST FRIENDS
NAME
ADDRESS
PHONE
NAME
ADDRESS
PHONE
SPOUSE INFORMATION
NAME
SSN#
ADDRESS
DATE OF BIRTH

MonthDayYear
Date
EMPLOYER
PHONE
HOW LONG:
YEARS
MONTHS
NET$

WEEKLYBI-WEEKLYBI-MONTHLYMONTHLY
SUPERVISOR
YOUR POSITION
PARENTS NAME
CO WORKER
ADDRESS
PHONE
CREDIT REFERENCES:
PEOPLE WHOM YOU HAVE BORROWED MONEY FROM AND PAID, AND PEOPLE YOU PRESENTLY OWE, AND, ANY RENTALS, I.E. RENT-TO-OWN
NAME
ADDRESS
PHONE
NAME
ADDRESS
PHONE
NAME
ADDRESS
PHONE
PERSONAL REFERENCES:

PEOPLE WHO KNOW YOU WELL (NOT IN HOUSEHOLD)
NAME
ADDRESS
PHONE
RELATIONSHIP
NAME
ADDRESS
Phone Number
Please enter a valid phone number.
RELATIONSHIP
NAME
ADDRESS
PHONE
RELATIONSHIP
NAME
ADDRESS
PHONE
RELATIONSHIP
NAME
ADDRESS
PHONE
RELATIONSHIP
CHILD SUPPORT: SECTION A

(OPTIONAL)
CHILD SUPPORT: SECTION A

PAYRECEIVE
HOW MUCH$
DATE PAID OR RECEIVED

MonthDayYear
Date
RECEIVED FROM OR PAID TO: NAME, ADDRESS & PHONE NUMBER
FIVE YEAR RESIDENCE HISTORY: SECTION B
ADDRESS
CITY, STATE
HOW LONG
ADDRESS
CITY, STATE
HOW LONG
ADDRESS
CITY, STATE
HOW LONG
ADDRESS
CITY, STATE
HOW LONG
ADDRESS
CITY, STATE
HOW LONG
FIVE YEAR WORK HISTORY: SECTION C
EMPLOYER
ADDRESS
HOW LONG?
EMPLOYER
ADDRESS
HOW LONG?
EMPLOYER
ADDRESS
HOW LONG?
EMPLOYER
ADDRESS
HOW LONG?
EMPLOYER
ADDRESS
HOW LONG?
OTHER INFORMATION:
ARE YOU A U.S. CITIZEN?

YESNO
HAVE YOU EVER HAD MERCHANDISE REPOSSESSED?

YESNO
WHAT UTILITIES ARE IN YOUR NAME?

ELECTRICITYGASTELEPHONEWATER
IF NOT IN YOUR NAME; WHOSE? (NAME, ADDRESS & PHONE)
HAVE YOU DECLARED BANKRUPTCY IN THE PAST TEN YEARS?

YESNO
IF YES, GIVE DATE FILED:

MonthDayYear
Date
IF YES, WHAT TYPE?

CHAPTER 7CHAPTER 11CHAPTER 13
WHERE DID YOU FILE?
CASE NO.
HAVE YOU BEEN DISCHARGED?

YESNO
IF YES, DATE DISCHARGED

MonthDayYear
Date
I HERBY CERTIFY THAT ALL STATEMENTS ARE TRUE AND COMPLETE AND ARE MADE FOR THE PURPOSE OF OBTAINING CREDIT. LUNDERSTAND THAT IF THE STATEMENTS ARE NOT MADE IN GOOD FAITH TO BE TRUE AND COMPLETE THAT SUCH IS CAUSE FOR DENIAL OF CREDIT. HAS PERMISSION TO INVESTIGATE OUR CREDIT.
DEALER NAME:FILL IN HAS PERMISSION TO INVESTIGATE OUR CREDIT HISTORY, AND ALL OTHER INFORMATION CONTAINED IN THIS APPLICATION.
APPLICANT'S SIGNATURE

Clear
SPOUSE'S SIGNATURE

Clear
DATE
Should be Empty:

CREDIT APPLICATION

YOUR MARITAL STATUS

HOW LONG

IF YES, GO TO CHILD SUPPORT PAGE 2, SECTION A

TWO BEST FRIENDS

SPOUSE INFORMATION

HOW LONG:

CREDIT REFERENCES:

PERSONAL REFERENCES:

CHILD SUPPORT: SECTION A

FIVE YEAR RESIDENCE HISTORY: SECTION B

FIVE YEAR WORK HISTORY: SECTION C

OTHER INFORMATION: