Credit Application

Applicant Personal Information

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First Name

Last Name

Cell Phone

Work Phone

Email address

Month

Day

Year

SSN (only 9 digits)

Driver’s License Number

Driver’s License Expiration Date

Applicant Residence

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Address

City

State

ZIP

Residence Type

Your Monthly Rentals

Year

Months

Applicant Employment Information

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Employment Status

Job Title

Gross Salary

Income Interval

Applicant Personal Reference Information.

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First name

Last name

Relationship

Work phone

Cell phone

Email Address

Address

City

State

ZIP

Year

Month

Driver’s License Number

Disclosure

I understand that you, and/or your assignees may retain this application and any other information you receive whether or not the application is approved. For purposes of this application, you are authorized to check my credit and employment history. I authorize any person or consumer reporting agency to furnish to you any information it may have or obtain in response to credit inquiries, whenever you make them.

I understand this partial application may not provide sufficient information to make a credit decision.
If this occurs, I agree to provide the additional information required to the dealer. If I do not provide this information,
I understand my application will be incomplete. I also understand that further information may be requested by you, the dealer, or any third party entities that provide credit.

In order to successfully transmit and receive the information and disclosures related to this credit application, I understand I must have an active Internet connection, a browser capable of sending and receiving secure information and the ability to print pages from this Web site for my records.

I consent to receive the information, follow-up communications, and disclosures related to this credit application and any subsequent credit transaction from you, your affiliates, agents and service providers, in writing, verbally, or electronically. This consent includes, but is not limited to, contact by manual calling methods, prerecorded or artificial voice messages, text messages, emails and/or automatic telephone dialing systems using any e-mail address or any telephone number I provide, now or in the future, including a number for a cellular phone or other wireless device, regardless of whether I incur charges as a result.

I agree that you, your affiliates, agents and service providers may monitor and record telephone calls regarding this credit application and any subsequent credit transaction to assure the quality of your service or for other reasons.

I understand that each time I submit a credit application, a notice will be placed on my credit report.

I certify that the information that I submit with this application is true and complete to the best of my knowledge.
I further certify that I am not contemplating a bankruptcy action at the present time, nor do I have any executions or pending legal proceedings against me. I recognize that providing false or fraudulent information is illegal and may be a basis for denying a discharge in bankruptcy.
I further certify that I have attained the age of majority.

Disclosure

I Understand and Accept the Terms and Conditions Above. *

Dealer information

Phone Number

(125) 882-6453

Company Contact

(125) 882-1124

Address

1912 Howard Street
Grand Rapids NY 49505

Opening Hours

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Email address

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