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CREDIT APPLICATION
NAME:_____________________________PHONE____________________________
ADDRESS_________________________________________________________ WORK PHONE _________________________
CITY _________________________STATE _____________ZIP__________________
SOCIAL SECURITY # ___________________DATE OF BIRTH __________________
HOW LONG AT ADDRESS: ____________________________
PREVIOUS ADDRESS IF LESS THAN 3 YEARS
______________________________________________________ HOW LONG______
BUYING OR RENTING ________________________
MONTHLY PAYMENT$_____________________ MADE TO __________________
EMPLOYMENT:
BUSINESS NAME ________________________________ HOW LONG___________
SUPERVISOR ____________________________________POSITION _____________
ADDRESS _______________________________________
_______________________________________
EARNINGS: MONTH $ ________________
PREVIOUS EMPLOYER IF LESS THAN 3 YEARS
BUSINESS NAME _________________________________ HOW LONG __________
SUPERVISOR ____________________________________ POSITION ___________
THE UNDERSIGNED HEREBY AUTHORIZED SELLING DEALER OR FINANCE COMPANY TO INITATE A CREDIT INVESTIGATION BASED UPON THE ABOVE INFORMATION, WHICH INFORMATION HAS BEEN VOLUNTARILY PROVIDED BY MYSELF, AND WARRANTS THE TRUTH AND ACCURACY OF THIS INFORMATION. THE UNDERSIGNED FURTHER WARRANTS THAT A BANKRUPTCY PROCEEDING IS NEITHER PRESENTLY IN PROGRESS NOR ANTICIPATED.
SIGNATURE OF APPLICANT _______________________________________________________
PRINT PAGE AND
RETURN FAX TO: 770-447-5332
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