Credit Application

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You Are:
 Date: / /

APPLICANT PERSONAL INFORMATION
Full Name: First: MI: Last:
Address:
Street # Direction Street Name Street Type Apt. # Rural Route
City: State: Zip:
Residential Status: Res. Payment: $ Value of Residence: $
How Long? Years:   Months: Home Phone: ( ) Cell Phone: ( )  
 
Email Address: (ex. johndoe@aol.com)
Date of Birth: Social Security #:
Marital Status: # of Dependents: Are you a US Citizen?:
               
Employer: Occupation: Type
Street # Direction
Street Name
 Street Type Apt. # Rural Route
Employer City: State: Zip: - Employer Phone: ( ) Ext.: - Years There: Months:
Annual Salary: $ . Bankruptcy?:       If Yes, What Year?:
         

CO-APPLICANT PERSONAL INFORMATION (If Applicable)
Relation to Applicant:
Full Name: First: MI: Last: Suffix:
Address:
Street # Direction
Street Name
 Street Type Apt. # Rural Route
City: State: Zip: - Residential Status:  
Res. Payment: $ Years There: Months:
Home Phone: ( ) - Cell Phone: (  )
Email Address: (ex. johndoe@aol.com) Date of Birth:
Social Security #:   - - Marital Status: # of Dependents:
Employer: Occupation: Type:  
Employer City: State: Zip: -
Employer Phone: ( ) - Ext.: Years There: Months:
Annual Salary: $ . Bankruptcy?: If Yes, What Year?:
                                             
TRADE-IN INFORMATION (If Applicable)
Trade-In Make: Trade-In Model:
Trade-In Year: Lien holder and Phone#:
Amount Owed: $ . Fair Market Value: $ .

Preferred Contact Method:
   



ACKNOWLEDGEMENT
 

I (we) authorize and acknowledge that consumer credit reports and employment history reports about me will be requested by Select Choice R.V. Center and third parties in connection with this application and/or on an ongoing basis in connection with updates, renewals, extensions or enforcement of any credit granted as a result of this application. I (we) certify that all of the information in this application is complete and accurate to the best of my (our) knowledge. Third party creditors will rely on this application in deciding whether to grant the credit request. I (we) authorize the sharing of information obtained in connection with this credit request, and any resulting loan, between Select Choice R.V. Center and any third party creditor that evaluates the credit request. I (we) agree that this application shall be and remain the property of Select Choice R.V. Center and any third party creditors that evaluate this credit request, whether or not this application is approved. Please note that alimony, child support or separate maintenance income need not be revealed if it is not to be considered as a repayment source for the loan.

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