Credit Application

Seller's
Name:

REVOLVING
CREDIT APPLICATION

(if checked, see rates here)

Merchandise Purchased:

IF YOU ARE MARRIED, you may apply for either joint or individual credit. You also have the right to request that the credit bureau maintain separate credit histories on you and your spouse.

BUYER'S APPLICATION

Note: Always include previous address and employment, if any.

(PLEASE PRINT)

Date

DLR NO.

SALE AMOUNT
$

DOWN PAYMENT
-$

AMOUNT FINANCED
$

MINIMUM PAYMENT
$

BUYER

JOINT BUYER

First Middle Last	First Middle Last
Age Date of Birth Social Security No.	Age Date of Birth Social Security No.
Home Phone Tele. Service in the name of No. of Children under 18 at home
Street Address Apt No. City State Zip
Residence Type Own or Buying Rent With Relatives Time at Residence Yrs. Mos. Mortgage Rent Payment (incl. tot. pmt.) $
Name of Mortgage Holder or Landlord City State Zip Phone
Previous Address City State Zip Time at Residence Yrs. Mos.
Bank Name Checking Address Phone Account No.

BUYER EMPLOYMENT

JOINT BUYER EMPLOYMENT

Present Employer	Present Employer
Address City State	Address City State
Phone Position	Phone Position
Income $ per Gross Take Home Time Employed Yrs. Mos.	Income $ per Gross Take Home Time Employed Yrs. Mos.

BUYER PREVIOUS EMPLOYMENT

JOINT BUYER PREVIOUS EMPLOYMENT

Present Employer	Present Employer
Address City State	Address City State
Phone Time Employed Yrs. Mos.	Phone Time Employed Yrs. Mos.

CREDIT REFERENCES

Auto:

City, State

Account No.

Monthly Pmt./Balance
$ $

City, State

Account No.

Monthly Pmt./Balance
$ $

City, State

Account No.

Monthly Pmt./Balance
$ $

City, State

Account No.

Monthly Pmt./Balance
$ $

City, State

Account No.

Monthly Pmt./Balance
$ $

LIST THREE RELATIVES OR FRIENDS YOU HAVE KNOWN AT LEAST 5 YEARS

Name
1)

Address

City, State

Phone

Please read the following carefully before signing:

Everything that I have stated in this application is correct to the best of my knowledge. I understand that you will retain this application whether or not it is approved. You are authorized to check my credit and employment history.

Applicant's Signature ↓

↓ Other Signature (Where applicable)

↓ SIGN BELOW by using your MOUSE ↓

NOTE: If you are unable to sign online, please submit the form without the signature.
Date:

The Federal Equal Opportunity Act prohibits creditors from discriminating against applicants on the basis of sex or marital status. The Federal Agency which administers compliance with this law concerning this dealer is the Federal Trade Commission, Washington DC 20580

___________________________________________________________

Seller's Signature

Date