CoolNow™ Credit Application Form

1

What's Your Full Name* This field is required.Please enter your First and Last name

First Name

Middle Name

Last Name

Suffix

2

What's Your Phone Number* This field is required.Enter your Phone Number

3

What's Your Email* This field is required.Enter your email address

4

What's Your Address* This field is required.Please enter your residential address

Street Address

Street Address Line 2

City

State

Zip Code

Country

5

Which County are you in?* This field is required.

Select your County

6

What's your Birth Date?* This field is required.

Date

7

What's your Social Security Number* This field is required.No worries, No hard inquiries on your credit report

Enter Your SSN no commas or separations

8

What's your Driver's License Number* This field is required.We'll keep your info secured, we promise!

Enter Your DL no commas or separations

9

Where was your Driver's License Issued?* This field is required.

Please select

10

When was your Driver's License Issued?* This field is required.

Date

11

When does your Driver's License Expire?* This field is required.

Date

12

Are you listed on the Property Title?* This field is required.

YESNO

13

Anyone else on the Title?* This field is required.

YESNO

14

If Yes, who?* This field is required.

15

What's their Full Name?* This field is required.

First Name

Last Name

16

What's their Email address?* This field is required.

17

What's their Phone Number?* This field is required.

18

What's their Birth Date?* This field is required.

Date

19

What's their SSN?* This field is required.No worries, No hard inquiries on their credit report neither

Enter Your SSN no commas or separations

20

What's their Driver's License Number* This field is required.We'll keep their info secured, we promise!

Enter Your DL no commas or separations

21

Where was your Driver's License Issued?* This field is required.

Please select

22

Are your mortgage payments up-to-date?* This field is required.

YESNO

23

Are your Property Taxes on time the last 3 years?* This field is required.

YESNO

24

Do you carry Homeowners Insurance?* This field is required.

YESNO

25

What's your Employment Status?* This field is required.

26

What's your Main Income source?* This field is required.

27

How much do you receive?* This field is required.

29

Date of your last paycheck?* This field is required.

Date

30

Employer / Company Name* This field is required.

31

Employer/Company Phone Number* This field is required.

Area Code

Phone Number

32

What's your position?* This field is required.

33

How many years working at this job?* This field is required.

34

Any other source of income?* This field is required.

35

If so, how much per month?* This field is required.

All your extra income combined

37

What's your Credit Score?* This field is required.Relax...this won't affect your application. We have financing options for most cases including low credit scores. No hard inquiries on your credit report neither.

38

Do you have a Bank Account?* This field is required.

YESNO

39

Bank Name* This field is required.

40

Account Number* This field is required.

41

Routing Number* This field is required.

42

Account Type* This field is required.

43

What size is your HVAC Unit?

44

What's your HVAC Unit brand?

45

Type of HVAC Unit

46

Do you need Ductwork?

47

If possible, please upload a picture/video of your actual Unit (Optional) This will help us to offer you the best system for your property

Drag and drop files here

Select files to upload

Max. file size: 2.0MB

Upload pictures of your inside and outside AC unit

48

Privacy Policy* This field is required.

By checking this box and submitting this application, I authorize CoolNow™ / Climacore HVAC & R, LLC and its financing partners to obtain and review my credit information as required to process my financing request. This may include a soft or hard credit inquiry, which could impact my credit score.

I understand that all information provided in this application is confidential and securely stored in compliance with Florida state laws and federal regulations, including the Fair Credit Reporting Act (FCRA) and the Gramm-Leach-Bliley Act (GLBA). CoolNow™ / Climacore HVAC & R, LLC does not sell, rent, or share my personal data beyond what is necessary to process my application.

49

Terms and Conditions* This field is required.

50

Please verify that you are human* This field is required.