Finance

CREDIT APPLICATION

Please fill out the form below and then click on submit

*First Name
*Last Name
*Middle Initial
*Street Address
Address (cont.)
*City
*State
*Zip/Postal Code
Work Phone
Home Phone
*E-mail
*Date of Birth
*Social Security #

Information on your residence

Please choose only one
Own Lease Rent

House Pmt or Rent
Length of Residence	Years
Landlord/Mortgage
Holder's Name

Employed By:	Self Others
*Employer Name
*Employer Address
*Employer City
*Employer State
*Employer Phone
*Length of Employment	Years
*Gross Monthly Wages	before taxes
*Job title or occupation

Automobile Credit History

Have you financed or leased a car before?	Yes No
Vehicle Financed Through
Payoff on this vehicle

*Signature of Applicant:

*Date:

I/We affirm that all the information in this credit application is complete and true, whether completed by me/us or by you at my/our direction. During the review of my/our credit application, you may obtain my/our credit history and/or a consumer report, and if the application is approved you may at any time obtain additional credit history to review my/our account. I/We also give any other source my/our permission to give you credit information about me/us.

The Ohio laws against discrimination require that all creditors make credit equally to all creditworthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law..