Greenplanet

Loan Application Form

GREEN PLANET SCOOTERS AND NATIONAL POWERSPORTS FINANCING
Contact Information
Title:
Name*

First NameLast Name
Birth Date

MonthDayYear
Marital Status:*

SingleMarriedOther
SIN Number
E-mail*
example@example.com
Phone*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long have you lived in your given address?*

0-1 Year1-2 Years3-4 Years5+ Years
Employment Information
Present Employer*
Occupation*
How Long at Employer?*

0-1 Year1-2 Years3-4 Years5+ Years
Gross monthly income*
Monthly rent/mortgage*
Down Payment Amount*
Comments:
I authorize prospective Credit Grantors/Lending/Leasing Companies to obtain personal and credit information about me from my employer and credit bureau, or credit reporting agency, any person who has or may have any financial dealing with me, or from any references I have provided. This information, as well as that provided by me in the application, will be referred to in connection with this lease and any other relationships we may establish from time to time. Any personal and credit information obtained may be disclosed from time to time to other lenders, credit bureaus or other credit reporting agencies. **

YES
I hereby agree that the information given is true, accurate and complete as of the date of this application submission. **

YES
Should be Empty:

Loan Application Form