Back to Home Credit Application Credit Application Dealer: MOUNT ORAB SALES, SERVICE & TOWING Check Appropriate Box If you are applying for individual credit in your own name and are relying on your own income or assets and not the income or assets of another person as the basis for repayment of the credit requested, complete Sections A and C. If this is an application for joint credit with another person, complete all Sections, providing information in Section B about the joint applicant. If you are applying for individual credit, but are relying on income from alimony, child support, or separate maintenance or on the income or assets of another person as the basis for repayment of the credit requested, complete all sections to the extent possible, providing information in Section B about the person upon whose alimony, support, or maintenance payments or income or assets you are relying. We intend to apply for joint credit (please initial)- Applicant Clear Co-Applicant Clear Amount Requested: Payment Date Desired: Proceeds of Credit to be Used for: SECTION A-APPLICANT INFORMATION Full Name: Full Name: First Name First Name Middle Name Middle Name Last Name Last Name Email Social Security Number: Driver's License Number: State: Birth Date Current Street Address: How Long? City: State: Zip: Phone(H): Phone(C): Housing Status (Mortgage, Rent, etc.): Monthly Rent/Mortgage: Landlord/Mortgage Holder: Landlord Phone: Previous Street Address: How Long? City: State: Zip: Monthly Rent/Mortgage at Previous Address: Employment Status (Employed, Retired, etc.) Salary: Current Employer: Phone: How Long? Possition/Occupation: Employer Address: Previous Employer: How Long? 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: Per Source of Other Income: Reference: Relationship: Phone: Address: Bank Reference: Phone: Type: Checking Savings SECTION B-JOINT APPLICANT OR OTHER PARTY INFORMATION Relationship to Applicant (Spouse, Relative, etc.): Full Name: Full Name: First Name First Name Middle Name Middle Name Last Name Last Name Email Social Security Number: Driver's License Number: State: Birth Date Current Street Address: How Long? City: State: Zip: Phone(H): Phone(C): Housing Status (Mortgage, Rent, etc.): Monthly Rent/Mortgage: Landlord/Mortgage Holder: Landlord Phone: Previous Street Address: How Long? City: State: Zip: Monthly Rent/Mortgage at Previous Address: Employment Status (Employed, Retired, etc.) Salary: Current Employer: Phone: How Long? Possition/Occupation: Employer Address: Previous Employer: How Long? 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: Per Source of Other Income: Reference: Relationship: Phone: Address: Bank Reference: Phone: Type: Checking Savings SECTION C- SIGNATURES Everything that I have stated in this application is correct to the best of my knowledge. I understand that you will retain this application whether or not it is approved. You are authorized to check my credit and employment history and to answer questions about your credit experience with me. Applicant Name * Joint or Other Name (where applicable) Applicant Signature * Clear Date * Joint or Other Signature (where applicable) Clear Date * SECTION D-NOTICES Notice to residents of ARIZONA, CALIFORNIA, IDAHO, LOUISIANA, NEVADA, NEW MEXICO, TEXAS, WASHINGTON, or WISCONSIN: If you are married and live in a community property state, the creditor may ask you to provide personal credit information about your spouse. Unless your spouse chooses to be a joint applicant for the credit requested, your spouse is not required to be a joint applicant Notice to residents of CALIFORNIA: Applicant, if married, may apply for a separate account. Notice to residents of MAINE: You have the right to purchase required insurance through the agent and insurer of your choice whether or not they are affiliated with the creditor and as long as they are reasonably acceptable to the creditor. Your choice of a particular insurance agent or broker does not affect credit decisions by the creditor to the extent that the agent or broker is reasonably acceptable to the creditor. Notice to residents of NEW HAMPSHIRE: If this is an application for a balloon retail sales contract, applicants are entitled, upon request, to receive a written estimate of the monthly payment for a balloon payment refinancing in accordance with the creditor's current refinancing programs prior to entering into a balloon contract. Notice to residents of OHIO: 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 residents of WISCONSIN: MARITAL PROPERTY AGREEMENT NOTICE: No provision of any marital property agreement, unilateral statement under Wisconsin Statutes Section 766.59, or court decree under Wisconsin Statutes Section 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. ALL APPLICANTS: IMPORTANT APPLICANT INFORMATION You authorize us to obtain consumer credit reports from time to time as we want, for any legitimate purpose, in connection with the transaction that is proposed by this application or any future update, renewal, or extension of that transaction. Upon request, you will be informed whether or not a consumer report was ordered. If a report was requested, you will be informed of the name and address of the consumer credit reporting agency that fumished the report. We may keep this application whether or not it is approved. By signing below, you agree that we may contact any party mentioned in this application to verify the information contained herein or otherwise underwrite credit. You authorize us to check your credit and employment history and to answer questions others may ask us about your credit record with us. If an account is created for you: a) you agree that we and our assignee may monitor and record your telephone communications to assure the quality of service, as the law allows; and b) you expressly consent to receive calls and text messages from us or our assignee at any number you have given us, you provide to us or our assignee in the future, or we or our assignee get from another source, including calls and messages made using an automatic telephone dialing system or artificial/prerecorded voice message, even If the number is for a mobile telephone and/or our using the number results in charges to you. FAIR CREDIT REPORTING ACT DISCLOSURE: This application may be submitted to the following financial institutions (include name and address of each institution): Mid-Atlantic Finance Co 4592 ULMERTON RD; CLEARWATER, FL 33762 MOUNT ORAB SALES, SERVICE & TOWING 480 W MAIN ST; MOUNT ORAB, OH 45154 Credit Acceptance Corporation P.O. Box 513; SOUTHFIELD, MI 48037 By signing below you acknowledge that you have read the applicable notices on this page and agree to these terms. Applicant Name * Joint or Other Namw (where applicable) Applicant Signature * Clear Date * Joint or Other Signature (where applicable) Clear Date Submit If you are human, leave this field blank.
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