CREDIT APPLICATION APPLICANT INFORMATION NAME * First Name Last Name Email DOB * MM DD YYYY SSN * ADDRESS * Address 1 Address 2 City State/Province Zip/Postal Code Country HOW LONG HAVE YOU LIVED THERE? * HOME PHONE (###) ### #### CELL PHONE * (###) ### #### RESIDENTIAL STATUS * MONTHLY RENT/MORTGAGE PMT * PREVIOUS ADDRESS (if less than 2 yrs at current address) Address 1 Address 2 City State/Province Zip/Postal Code Country CURRENT EMPLOYER'S NAME * CURRENT EMPLOYER ADDRESS * GROSS MONTHLY SALARY * WORK PHONE * (###) ### #### OCCUPATION TITLE * HOW LONG HAVE YOU WORKED THERE? * PREVIOUS EMPLOYER (if less than 2 yrs on current job) HOW LONG DID YOU WORK THERE FOR? GROSS MONTHLY OTHER INCOME OTHER INCOME NOTE: Alimony, child support, or separate maintenance do not have to be revealed unless the applicant wishes to have such sources considered as a basis for repayment of the requested credit amount. OTHER INCOME SOURCE JOINT APPLICANT NAME * if no joint applicant, please enter "N/A" FAIR CREDIT REPORTING ACT TO CONSUMER * THIS WILL ADVISE YOU THAT YOUR RETAIL INSTALLMENT SALES CONTRACT AND BUYER'S APPLICATION FOR SECURED DEBT WILL BE SUBMITTED TO FINANCIAL INSTITUTIONS AND THEIR AFFILIATES FOR PURCHASE AND CONSIDERATION AS TO WHETHER YOU MEET THEIR CREDIT REQUIREMENTS. THE UNDERSIGNED FURTHER AUTHORIZES THESE FINANCIAL INSTITUTIONS AND THEIR AFFILIATES TO OBTAIN SUCH INFORMATION THAT THEY MAY REQUIRE IN ORDER TO VERIFY INFORMATION RELATIVE TO THIS REQUEST, INCLUDING CONTACTING SPOUSES TO VERIFY SPOUSE RELATED INFORMATION. I CERTIFY THAT ALL INFORMATION GIVEN BY ME ON THIS APPLICATION IS COMPLETE AND ACCURATE. I GIVE MY PERMISSION FOR ANY FINANCIAL INSTITUTION WHICH WILL REVIEW THIS CREDIT APPLICATION TO INVESTIGATE MY CREDIT AND EMPLOYMENT HISTORY, AND TO ANSWER QUESTIONS ABOUT THEIR CREDIT EXPERIENCE WITH ME INCLUDING BUT NOT LIMITED TO LATE PAYMENTS, MISSED PAYMENTS OR OTHER DEFAULTS, AND THIS INFORMATION MAY BE REPORTED IN YOUR CREDIT REPORT. I AGREE APPLICANT SIGNATURE * APPLICANT DRIVER'S LICENSE # * Thank you! JOINT APPLICANT INFORMATION Name * First Name Last Name Email DOB * MM DD YYYY SSN * ADDRESS * Address 1 Address 2 City State/Province Zip/Postal Code Country HOW LONG HAVE YOU LIVED THERE? * HOME PHONE (###) ### #### CELL PHONE * (###) ### #### RESIDENTIAL STATUS * MONTHLY RENT/MORTGAGE PMT * PREVIOUS ADDRESS (if less than 2 yrs at current address) Address 1 Address 2 City State/Province Zip/Postal Code Country CURRENT EMPLOYER'S NAME * CURRENT EMPLOYER ADDRESS * GROSS MONTHLY SALARY * WORK PHONE * (###) ### #### OCCUPATION TITLE * HOW LONG HAVE YOU WORKED THERE? * PREVIOUS EMPLOYER (if less than 2 yrs on current job) HOW LONG DID YOU WORK THERE FOR? GROSS MONTHLY OTHER INCOME OTHER INCOME NOTE: Alimony, child support, or separate maintenance do not have to be revealed unless the applicant wishes to have such sources considered as a basis for repayment of the requested amount. OTHER INCOME SOURCE FAIR CREDIT REPORTING ACT TO CONSUMER * THIS WILL ADVISE YOU THAT YOUR RETAIL INSTALLMENT SALES CONTRACT AND BUYER'S APPLICATION FOR SECURED DEBT WILL BE SUBMITTED TO FINANCIAL INSTITUTIONS AND THEIR AFFILIATES FOR PURCHASE AND CONSIDERATION AS TO WHETHER YOU MEET THEIR CREDIT REQUIREMENTS. THE UNDERSIGNED FURTHER AUTHORIZES THESE FINANCIAL INSTITUTIONS AND THEIR AFFILIATES TO OBTAIN SUCH INFORMATION THAT THEY MAY REQUIRE IN ORDER TO VERIFY INFORMATION RELATIVE TO THIS REQUEST, INCLUDING CONTACTING SPOUSES TO VERIFY SPOUSE RELATED INFORMATION. I CERTIFY THAT ALL INFORMATION GIVEN BY ME ON THIS APPLICATION IS COMPLETE AND ACCURATE. I GIVE MY PERMISSION FOR ANY FINANCIAL INSTITUTION WHICH WILL REVIEW THIS CREDIT APPLICATION TO INVESTIGATE MY CREDIT AND EMPLOYMENT HISTORY, AND TO ANSWER QUESTIONS ABOUT THEIR CREDIT EXPERIENCE WITH ME INCLUDING BUT NOT LIMITED TO LATE PAYMENTS, MISSED PAYMENTS OR OTHER DEFAULTS, AND THIS INFORMATION MAY BE REPORTED IN YOUR CREDIT REPORT. I AGREE APPLICANT SIGNATURE * APPLICANT DRIVER'S LICENSE # * Thank you!
