David Fritts Outdoors Credit Application

CONSUMER CREDIT APPLICATION		Date:__________________________
Dealer: David Fritts Outdoors Phone: 336-731-2232 FAX 336-731-1248 Contact: Mark
APPLICANT
Social Security No:	Application Type: Ind: [ ] Joint: [ ]	Amount Requested: $	Purpose:
Name: First:	Middle	Last	No. Dependents:
Address (No. and Street)	City:	State:	Zip:
County:	Home Phone:		Date of Birth:
Specify for joint or secured credit only: Married [ ] Separated: [ ] Unmarried (Single, Divorced, Widowed) [ ]
Buying [ ] Rent [ ] Own [ ] Other (Please specify) [ ]		Monthly Rent/Mortgage $
Mortgage Co. [ ] Landlord [ ]	Name:	Address:
Date Purchased	Purchase Price: $		Account No.:
Mortgage Balance: $	Market Value: $	Time at Residence: Years: Months:
Previous Residence: (Street/City/State):		Time at Residence: Years: Months:
Mortgage Co. [ ] Landlord [ ]	Name:	Address:
Present Employer - Name:		Address:
City:		State:	Phone No:
Occupation	Length of Employment Years [ ] Months [ ]	Gross Monthly Salary $	Net Monthly Salary $
Previous Employer Name:	City/State		Phone No:
Occupation:		Length of Employment - Years [ ] Months [ ]
Nearest Relative:		Address:
Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Other Income: Source		Monthly Amount $
Has Applicant declared bankruptcy? Yes [ ] No [ ]
CO-APPLICANT
Social Security No:
Name: First:	Middle	Last	No. Dependents:
Address (No. and Street)	City:	State:	Zip:
County:	Home Phone:		Date of Birth:
Specify for joint or secured credit only: Married [ ] Separated: [ ] Unmarried (Single, Divorced, Widowed) [ ]
Buying [ ] Rent [ ] Own [ ] Other (Please specify) [ ]		Monthly Rent/Mortgage $
Mortgage Co. [ ] Landlord [ ]	Name:	Address:
Date Purchased	Purchase Price: $		Account No.:
Mortgage Balance: $	Market Value: $	Time at Residence: Years: Months:
Previous Residence: (Street/City/State):		Time at Residence: Years: Months:
Mortgage Co. [ ] Landlord [ ]	Name:	Address:
Present Employer - Name:		Address:
City:		State:	Phone No:
Occupation	Length of Employment Years [ ] Months [ ]	Gross Monthly Salary $	Net Monthly Salary $
Previous Employer Name:	City/State		Phone No:
Occupation:		Length of Employment - Years [ ] Months [ ]
Nearest Relative:		Address:
Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Other Income: Source		Monthly Amount $
Has Co-Applicant declared bankruptcy? Yes [ ] No [ ]
The following information pertains to both Applicant and Co-Applicant.
Auto #1 Year [ ]	Clear Title Yes [ ] No [ ]	Auto #2 Year [ ]	Clear Title Yes [ ] No [ ]
Savings / Bank Name	Acc No:	Savings / Bank Name	Acc No:
List below all debts now owing (Include other large monthly payments for medical expenses, insurance, alimony or support). Under the column "Debtor", Identify Applicant's debts with the letter (A) and Co-Applicants debts with the letter (C).
Debtor	Creditor	Payment $	Balance Due $
Debtor	Creditor	Payment $	Balance Due $
Debtor	Creditor	Payment $	Balance Due $
Debtor	Creditor	Payment $	Balance Due $
The following party will be requested to extend credit in connection with this transaction: (Insert Branch Name and Address in the above space.)		By signing this application you promise that all information is true and complete. You also promise that you have revealed any pending lawsuits or unpaid judgments against you. You intend the seller and /or assignee to rely upon these promises in deciding whether to extend credit to you. You authorize a full investigation of your credit record and your employment history. You also authorize the seller and / or assignee to release information about your credit experience with them. Read special notices before signing. We may share the above information with our affiliates, unless you instruct us not to by checking here ______. Applicant Signature ________________________________ Co-Applicant Signature_______________________________