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Applicant Information

Applicant Full Name

Social Security Number
Date of Birth

Current Mailing Address (physical address required)

Address

City
State
Zip

Home Phone Number
How Long Have You Lived There?

Monthly Housing Payment		 Own Rent Other

Current Employer
Name

 Work Phone


Address

City
State
Zip

Gross Income Per Month
Position
How long have you worked there?

Other Income Source*
Other Income Amount*

*Alimony, Child Support, and/or Separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Previous Employer (if less than 2 years at current employer)

Name
How long did you work there?

 

Joint/Co-Signer Applicant Information

Joint/Co-Signer Applicant Full Name

Social Security Number
Date of Birth

Relationship (if any)

Current Mailing Address

Address

City
State
Zip

Home Phone Number
How Long Have You Lived There?

Monthly Housing Payment		 Own Rent Other

Current Employer

Name
Work Phone
City
State
Zip
 

Gross Income Per Month
Position
How long have you worked there?

Other Income Source*
Other Income Amount*

*Alimony, Child Support, and/or Separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

References

Name
Home Phone Number

City
State

Relationship

Name
Home Phone Number

City
State

Relationship

 

FINANCIAL PROTECTION PLAN (GAP) HAS BEEN PRESENTED AND I CHOOSE TO (check one):
Accept Decline   this protection. Initial:
PAYMENT PROTECTION PLAN (CREDIT LIFE & DISABILITY) HAS BEEN PRESENT AND I CHOOSE TO: (check one):
Accept Decline   this protection. Initial:
Coverage, rates and availability may vary by state. Delaer origination may affect the cost and terms of the offer. Credit approval is not based on your decision to accept of decline the coverage.

NOTICE TO APPLICANT(S) & AUTHORIZATION BY APPLICANT(S):

This Credit Application-Consumer Statement will be submitted to Auto RV Centerk, and its successors and assigns for consideration of whether it meets the credit requirements.

Applicant(s) hereby authorize(s) an investigation of his/her/their credit and employment history. Applicant(s) understand(s) that his/her/their credit and employment history obtained in and in connection with this Credit Application-Customer Statement will be used in determining his/her/their eligibility for credit approval.

Applicant will be required to obtain and pay for vehicle insurance covering the collateral for the full term of the loan, for liability and physical damage for both collision and comprehensive losses to include such perils as FIRE, THEFT, and VANDALISM. Eaglemark Savings Bank, and its successors and assigns, must be listed as a LOSS PAYEE AND ADDITIONAL INSURED. Applicant will provide verification in the form of a certificate of insurance through an acceptable carrier with thirty (30) days notice of any intent to cancel or non-renew to be provided by the issuing carrier to the applicant and loss payee. YOU MAY CHOOSE THE PERSON THROUGH WHOM ANY INSURANCE IS OBTAINED.

NOTICE TO CALIFORNIA RESIDENTS: Regardless of your marital status, you may apply for credit in your name alone.

NOTICE TO MAINE RESIDENTS: Consumer reports (credit reports) may be requested in connection with this application. Upon request, you will be informed whether or not a consumer report was requested and, if it was, of the name and address of the consumer reporting agency that furnished the report.

NOTICE TO NEW YORK RESIDENTS: Consumer reports may be requested in connection with the processing of your application and any resulting account. Upon request, we will inform you of the names and addresses of any consumer reporting agencies which have provided us with such reports.

NOTICE TO OHIO RESIDENTS: Ohio laws against discrimination require that all creditors make credit equally available 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.

NOTICE TO RHODE ISLAND RESIDENTS: Consumer reports may be requested in connection with this application.

NOTICE TO VERMONT RESIDENTS: The creditor may obtain credit reports about you on an ongoing basis in connection with this extension of credit transaction for any one or more of the following reasons: (1) reviewing the account; (2) taking collection action on the account; or (3) any other legitimate purposes associated with the account.

NOTICE TO MARRIED WISCONSIN RESIDENTS: No provision of a marital property agreement, a unilateral statement under Wisconsin Statutes 766.59 or a court decree under Wisconsin Statutes 766.70 adversely affects the interest of the creditor unless the creditor, prior to the time the credit is granted, is furnished a copy of the agreement, statement or decree or has actual knowledge of the adverse provision when the obligation to the creditor is incurred.

I hereby certify that the information contained in this Credit Application-Customer Statement is complete and accurate to the best of my knowledge.

By sending below, I acknowledge that I have read the Notice to Applicant(s) & Authorization by Applicant(s) section, and I agree to the terms and conditions set forth in this Credit Applicant-Customer Statement.