| |
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) |
| |
|
|
