Denver Recreational Marine

3333 hwy 16n,  Denver N.C. 28037

704-483-2628

CREDIT APPLICANT INFO

Name (First, Middle, Last)                        Date of Birth                                            Social Security #

Number of Dependents

Address            (Street)                                                        (City)                                        (State)                                (Zip)

Telephone Number  (Area Code)555-1234

Time at Current Address:  Yrs/Months                                Own   Rent Live w/Parents or Relatives  Other-Explain

Mortgage or Rent Payment $

Name and Address of Current Employer                                Position                                                         Time W/Employer:  Yrs./Months

Business Phone

Monthly Gross Income $                                    Other Monthly Income $        Explain Source

CO-APPLICANT INFO

Name (First, Middle, Last)                            DOB                                       Social Security #                        Home Phone Number

Address    (Street)                                                    (City)                                                    (State)                                    (Zip)

TIme At Current Address: Yrs./Months                                    Monthly Gross Income $

Name and Address of Current Employer                       Position                                       Time w/Employer: Yrs./Months

Business Phone

DESCRIPTIONS OF GOODS BEING PURCHASED

Item                                    New/Used                        Year                        Manufacturer                                       Model

Sale Price $                    Down Payment if Any $

                    Year                                    Manufacturer                                        Model

TRADE-IN                                       

NOTICE TO APPLICANT:

The Fair Credit Report Act requires that we advise you that a routine inquiry may be made in the processing of your application, which will provide applicable information to the lender, concerning you character, general reputation, personal characteristics and mode of living.  Upon your written request additional information as to the nature and scope to the report if one is made will be provided to you.  Any willful misrepresentation on this statement could result in fine and/or imprisonment under provisions of the US criminal code

I Agree  I Disagree      Applicant's Name                                    E-mail Address

I Agree  I Disagree      Co-Applicant's Name                               

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