Home Phone:*
Cell Phone:
Date of Birth:*
Drivers License #:
Marital Status:
Time at Residence:
Time at Job:
Yearly Income:
Other Income:
Source of Other Income:
Name of Bank:
Type of Acct:
Bankruptcy History:
Are your wages garnished?
If garnished wages, by who?
Do you have any repo's?
How many repo's?
I certify that everything I have stated in this application is correct. *
By submitting this credit application, I verify that the information provided is complete and accurate to the best of my knowledge. I further authorize an investigation of my credit and employment history, to have a consumer credit report prepared on me for the purpose of evaluating the is application for credit, and to answer any questions other may ask of you about my credit record with you. I understand that I must update this information at the request of Fleetwood Motors if my financial condition changes.
Digital Signature: *