Credit Application

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 *

Previous Address ( If less than 2 years present)

Employer Address

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)
Previous Employer (if less than 2 years at current employer)
Occupation
Previous Employer Phone Number

- Area Code Phone Number

Employer Address

Present Address

Previous Address (If less than 2 years at present address)

Employer Address

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)
Are there any unsatisfied judgement against you? *
If Yes Explain:
Have you been declared bankrupt in the last 10 years? *
If Yes Explain:
Have you ever voluntarily surrendered or had an auto, appliance or any other item repossessed? *
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
Should be Empty:

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