FOSTERS FARM & EQUIPMENT SUPPLY
Consumer Credit Application
APPLICANT
First Name Middle Last Name
Status
Social Security No Birth Date DL# DL State
Current Address City State Zip
Years There Status
Mortgage Lender Monthly Payment Balance
Previous Address Years There
Home Phone Mobile Phone Work Phone
Email
(If less than 2 yrs at current)
EMPLOYMENT
(If less than 3 yrs with current)
Previous Employer Years There
Other income sources need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
REFERENCES
Everything I have stated on this application is true to the best of my knowledge and is given for the purpose of obtaining credit. I understand ETAC will retain this application whether or not it is approved. ETAC and any other creditor or prospective creditor of the undersigned are authorized to make investigations concerning the undersigned or concerning the above information and to disclose to each other the information set forth above and the results of such information.
Applicant's Electronic Signature Date
Employer Name Occupation Years There
Employer Address
Gross Monthly Income Other Income Source Amount
(Not Living With You)
Name of Nearest Relative
Address Phone
Have you had any judgements, foreclosures, or bankruptcies in the past 10 years?
If YES, explain:
CO-APPLICANT
CO-APP EMPLOYMENT
CO-APP REFERENCES
First Name Middle Last Name
Status
Social Security No Birth Date DL# DL State
Home Phone Mobile Phone Work Phone
Email
Current Address City State Zip
Years There Status
Mortgage Lender Monthly Payment Balance
Previous Address Years There
Employer Name Occupation Years There
Employer Address
Gross Monthly Income Other Income Source Amount
Other income sources need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Previous Employer Years There
Have you had any judgements, foreclosures, or bankruptcies in the past 10 years?
If YES, explain:
Name of Nearest Relative
Address Phone
Co-Applicant's Electronic Signature Date
FINANCING INFORMATION
(If less than 2 yrs at current)
(If less than 3 yrs with current)
(Not Living With You)
Vehicle Being Financed Pricing
Trade Information
Ordered Unit Year Make Model
MSRP Invoice
Serial/Vin
Year Make Model Lein Holder and Contact
Finance Amt
Trade Payoff
Cash Down
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Salesman (Required field, if none please type None)