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Credit Application
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APPLICATION TYPE
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Corporation Tax ID Number, if applicable
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Salesperson you spoke with (important)
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PERSONAL INFORMATION
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Purchaser To Drive
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... If No ...
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Drivers Name |
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License # |
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Date Of Birth |
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Primary Applicant |
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Full Name |
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License No. |
(With State + Expiration Date)
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Date Of Birth |
Age
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S.S. Number |
No. Dependents
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Business Phone |
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Residence Phone |
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Spouse |
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Full Name |
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Date Of Birth |
Age
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S.S. Number |
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Present Address |
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Address Line 1 |
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Address Line 2 |
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City-State-ZIP |
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How long? |
Years & Months
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Own/Rent |
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Mortgage/Rent Paid To |
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Former Address |
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Address Line 1 |
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Address Line 2 |
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City-State-ZIP |
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CORPORATION INFORMATION
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Corporation Name |
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Incorporated in what state? |
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Date Of Incorporation |
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Date In Business |
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Principal |
Age
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Principal Title |
% Owned
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Principal |
Age
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Principal Title |
% Owned
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NEAREST RELATIVES NOT AT ABOVE ADDRESS
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EMPLOYMENT - PAST & PRESENT - FIVE YEARS
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TRADE-IN DESCRIPTION
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Truck |
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PURCHASER'S FINANCIAL & CURRENT CREDIT STATEMENT
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Examples: How To Fill Out This Section
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Description |
Bank |
Phone # |
Acct # |
Asset
Value |
Payment
Amount |
Amount You Owe |
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Checking Acct |
First Bank |
800-888-8888 |
123456789 |
4200 |
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Savings Acct |
First Bank |
800-888-8888 |
123456789 |
2450 |
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Ford Bronco Loan |
Fifth Bank |
313-333-3333 |
4567890 |
15000 |
525 |
7200 |
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1993 Freightliner FL120 |
National Bank |
555-555-1234 |
123-4568 |
21500 |
800 |
12500 |
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Home Loan |
City Savings Bank |
555-555-1212 |
595955 |
120000 |
925 |
91700 |
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Visa |
First Mutual |
800-111-2222 |
4415 3341 |
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100 |
6200 |
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Stock |
N/A |
N/A |
N/A |
8000 |
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Include:
- Assets - Real Estate, Savings Account, Trucks, Trailers, Autos, Loans
- Liabilities - Credit Cards, Fuel Bill, Etc.
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Have you filed bankruptcy in the last 10 years? |
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Any items repossessed? |
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SIGN & DATE
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The information given above is true and complete. Lender may receive from and disclose to other persons, including credit reporting agencies, information about Applicant's accounts and credit experience and Applicant authorizes any person to release to Lender credit experience and account information on Applicant. This shall be a continuing authorization for all present and future disclosures of account information and credit experience on Applicant made by Lender or any person requested to release such information to Lender.
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Disclaimer: "Email is not considered to be a completely secure medium for the transmission of sensitive information. Those who email credit application information do so at their own risk."
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