Credit Application

APPLICANT INFORMATION

* Name:

Date of birth:

SSN/Tax ID:

* Phone:

Current address:

City:

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ZIP:

Gross income (all sources):

Email:

Own Rent Other Family

Monthly payment or rent:

How Long:

EMPLOYMENT INFORMATION

Employer:

Employer Address:

How Long:

City:

State:

ZIP:

Phone:

Fax:

Position:

Hourly Salary

CO-APPLICANT INFORMATION IF FOR A JOINT ACCOUNT

Name:

Date of birth:

SSN/Tax ID:

Phone:

Current address:

City:

State:

ZIP:

Gross income (all sources):

Email:

Own Rent Other Family

Monthly payment or rent:

How Long:

CO-APPLICANT EMPLOYMENT INFORMATION

Employer:

Employer Address:

How Long:

City:

State:

ZIP:

Phone:

Fax:

Position:

Hourly Salary

AUTHORIZATION

By signing below, I authorize Shabbona Creek RV to verify the information provided on this form as to my credit and employment history.

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Applicant signature:

Co-Applicant signature (if used) :