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Credit Application
Print page and fax completed & signed form to:
(602) 437-9230 ($200 min. deposit, applicable to purchase)
  Important:
- If you are applying for individual credit in your own name and are relying on your own income or assets and the income or assets of another person as the basis for repayment, complete only section A
.
- If you are applying for joint credit with a Co-Applicant, complete both Section A and Section B, providing information in Section B about the Co-Applicant.

- If you are applying for individual credit but are relying on income or assets of another person as the basis for repayment, complete both Section A and Section B, providing information in Section B about the person on whose income or assets you are relying.
  Applicant Information - Section A (Please Print)
 
Name
Date of Birth SSN Marital Status
Street Address. Apt # Time There Home Phone
(       )
Previous Address(If at above less than 1 year) Time There
Current Employer Address Phone
(       )
Title/Position Supervisor Gross Monthly Earnings Drivers Lic. Number
Previous Employer(If less than 1 year shown above) Address Phone
(       )
Title/Position Time There(Years and Months) Supervisor
Other income Per Month Source(Alimony, child support, or seperate maintenance need not be revealed if you do not wish to have it considered as a basis for repaying obligation)
Name of Nearest Relative Relationship
Address of Nearest Relative Phone
(       )
  Landlord or First Mortgage Holder (Name and Address) Landlord's phone
 



 

Co-Applicant or Other Additional Party Information - Section B

 
Name
Date of Birth SSN Relationship to Applicant (If Any)
Street Address. Apt # Time There Home Phone
(       )
Previous Address(If at above less than 1 year) Time There
Current Employer Address Phone
(       )
Title/Position Supervisor Gross Monthly Earnings Drivers Lic. Number
Previous Employer(If less than 1 year shown above) Address Phone
(       )
Title/Position Time There(Years and Months) Supervisor
Other income Per Month Source(Alimony, child support, or seperate maintenance need not be revealed if you do not wish to have it considered as a basis for repaying obligation)
 
Each person signing this application (each person hereinafter referred to as "I") hereby certifies that everything I have stated in this application is correct to the best of my knowledge and is provided to Dwight Financial Inc., or one or more additional third party financial institions, at dealers discretion, for the purpose of initiating the extension of credit. I understand that potential lenders will retain this application whether or not it is approved. The ultimate lender is authorized to periodically check my credit and employment history and to provide information to others about its credit experience with me. Upon request I will be provided a copy of this credit application.
  __________________________________________________________

Applicant's Signature


___________________________________________________________________
Additional Parties' Signature
(Where Applicable)