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STANDARD CREDIT APPLICATION
Before completing this form please read the directions carefully. (Check appropriate box). Applicant, if married, may apply for a separate account.
APPLICANT’S CREDIT INFORMATION :
APPLICANT EMPLOYER INFORMATION
GROSS SALARY OR WAGES$pick one!
Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
THE OTHER PARTY’S CREDIT INFORMATION
RELATIONSHIP TO APPLICANT (IF ANY)
GROSS SALARY OR WAGES$pick one!
Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
VEHICLE INFORMATION TO BE COMPLETED BY SELLER

VEHICLE INSURANCE is required for the full term of the Contract, at your expense, against the hazards of fire, theft and accidental physical damage (including collision). This insurance must protect the interests of you and the lender. The policies issued by the insurance company will describe the terms and conditions. YOU MAY CHOOSE THE PERSON THROUGH WHOM ANY INSURANCE IS OBTAINED.

I/we, the undersigned (1) make the above representations, which are certified correct, for the purpose of securing credit; (2) authorize financial institutions to obtain consumer credit reports on me/us periodically and to gather employment history as they consider necessary and appropriate; (3) authorize your affiliates to obtain credit reports on me/us; (4) authorize financial institutions, affiliates, and others to exchange credit, account and financial information about me; (5) agree that if I/we gave you an e-mail address or cellular telephone number as a means of contacting me/us, you and any assignee to whom you may assign my/our credit agreement are specifically authorized to use that information to contact me/us regarding any credit account that you open for me/us;and (6) understand that the creditor or any financial institution to whom this application is submitted will retain this application whether or not it is approved, and that it is my/our responsibility to notify the creditor of any changes of name, address or employment.

FAIR CREDIT REPORTING ACT DISCLOSURE: This application for credit may be submitted to various financial institution(s). Before this application is submitted, the name(s) and address(es) of the institution(s) that will receive copies of this application will be disclosed to me/us. CA, NY, OH, RI, VT AND WI RESIDENTS: SEE THE REVERSE SIDE OF THIS APPLICATION FOR FURTHER IMPORTANT DISCLOSURES AND INFORMATION.

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