Credit Application
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Primary Applicant
Yes
Joint Application
Application is for joint credit with primary applicant or as a guarantor.
Primary Applicant is relying on you for income for alimony, child support, or separate maintenance or on your income or assets as the basis for repayment of the credit requested.
If Joint Applicant, Relationship to Applicant
S-Married
P-Parent
O-Other
Date Of Birth
*
-
Month
-
Day
Year
Date
We will contact you for your Social Security Number
Driver's License Number
*
Rent or Own
*
Rent
Own
Monthly Rent/Mortgage
*
Present Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Years Lived at Present Address
*
Previous Address ( If less than 2 years present)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Years Present at this address
Current Employer
*
Occupation
*
Gross Monthly Salary
*
Time on Job
*
Employer Phone Number
*
-
Area Code
Phone Number
Employer Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Additional Income (alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation)
What is the source of additional income?
Previous Employer (if less than 2 years at current employer)
Occupation
Previous Employer Phone Number
-
Area Code
Phone Number
Employer Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Gross Monthly Salary
Time on the Job
Co-Applicant
Co-Applicant Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
-
Area Code
Phone Number
Rent or Own
Rent
Own
Monthly Rent/Mortgage
Present Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Years Lived at this Address
Previous Address (If less than 2 years at present address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Current Employer
Employer Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employer Phone Number
-
Area Code
Phone Number
Occupation
Time on the Job
Gross Monthly Salary
Additional Income (alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation)
What is the source of additional income?
Are there any unsatisfied judgement against you?
*
Yes
No
If Yes Explain:
Have you been declared bankrupt in the last 10 years?
*
Yes
No
If Yes Explain:
Have you ever voluntarily surrendered or had an auto, appliance or any other item repossessed?
*
Yes
No
If Yes Explain
***For the purpose of securing credit from you, I certify that the above information is true and complete to the best of my knowledge. I authorize you, including any of your affiliates or designee's, to check my credit and employment history and to provide and/or obtain information about credit experience with me. I understand that this application will be retained by Lee's Country RV whether or not it is approved.
Applicant Signature
*
Co-Applicant Signature
Submit
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