Online Credit Application

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1 Step 1

This is a secure form

Phone
Nameyour full name
Check Appropriate Box

Note: Applicant, if married, may apply for a separate account.

SECTION A. Information Regarding Applicant
First Name
M.I.
Last Name
Date of Birth (mm/dd/yyyy)
Drivers License #
Social Security Number
Marital Status

Current Address: (Cover 5 Years Residence)

Address
City
Zip Code
Years?

Previous Address:

Address
City
Zip Code
Years?

Previous Address:

Address
City
Zip Code
Years?

Employment

Title
Employer
Address
How Long?

Previous Employment

Title
Employer
Address
How Long?

Previous Employment

Title
Employer
Address
How Long?

Nearest Relative Not Living With Applicant:

Name
Address
City
Zip Code
Phone No.
Email
Income
Applicants monthly income from employment (In USD):

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.

Alimony, child support, separate maintenance received under:
Alimony Payment (In USD):
Amount of other monthly income and source(s) (In USD):
SECTION B. Information Regarding Spouse or Co-Applicant
First Name
M.I.
Last Name
Date of Birth (mm/dd/yyyy)
Drivers License #
Social Security Number
Marital Status

Current Address (Cover 5 Years Residence):

Address
City
Zip Code
Years?

Previous Address:

Address
City
Zip Code
Years?

Previous Address:

Address
City
Zip Code
Years?

Employment

Title
Employer
Address
How Long?

Previous Employer

Title
Employer
Address
How Long?

Previous Employer

Title
Employer
Address
How Long?

Nearest Relative Not Living With Co-Applicant:

Name
Address
City
Zip Code
Phone Number
Email
Income
Applicants monthly income from employment (In USD):

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.

Alimony, child support, separate maintenance received under:
Alimony Payment (In USD):
Amount of other monthly income and source(s) (In USD):
SECTION C. Asset and Debt Information: List all debts including alimony, child support, separate maintenance, etc.
Housing
Landlord or Mortgage Holder
Holder's Address
City
Zip Code
Acct. #
Balance (In USD)
Payment/Rent
Purchase Date:
Age of Home:
Price Paid for Home

Credit Information

Type of Credit
Company Name
Account #
Status
Address
City
Balance
High:
Payment:

Credit Information

Type of Credit
Company Name
Account #
Status
Address
City
Balance
High:
Payment:

Bank Reference

Reference Name
Account #
Branch/Address
Account Type
Account Balance

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Have you ever had and property repossessed?
Do you have any lawsuits pending?
Have you ever filed bankruptcy or is a bankruptcy proceeding in progress or expected?
Military Reserve?

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Personal Friend Known Over A Year
Address
City
Zip Code
Phone Number
Email Address

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INSURANCE - IF YOU WISH TO APPLY FOR VEHICLE INSURANCE IN CONNECTION WITH THIS CREDIT APPLICATION, COMPLETE THE FOLLOWING:

Notice: No person is required as a condition pursuant to financing the purchase of a motor vehicle to purchase insurance through a particular insurance company, agent or broker.

Previous Insurance Co. or Agent
Phone
Policy #
Nameyour full name
Has your insurance ever been cancelled by any company?
If Yes, why?
0 /

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In the following sentence, the applicant/co-applicant is referred to as "I" and the creditor is referred to as "you and your". I, the undersigned (1) make the above representations, which are certified correct, for the purpose of securing credit; (2) authorize financial institutions to obtain consumer credit reports on me periodically and to gather employment history as they consider necessary and appropriate; (3) authorize your affiliates to obtain consumer credit reports on me; (4) UNLESS THE CHECKBOX THAT FOLLOWS IS CHECKED, I AUTHORIZE THE DEALER'S ASSIGNEE TO SHARE AND USE INFORMATION ABOUT ME, INCLUDING INFORMATION IN MY APPLICATION, WITH OTHER ENTITIES THAT ARE RELATED TO IT BY COMMON OWNERSHIP OR AFFILIATED WITH IT BY COMMON CONTROL. IF THE CIRCLE IS MARKED, I DIRECT THE DEALER'S ASSIGNEE NOT TO GIVE INFORMATION TO SUCH ENTITIES (OTHER THAN INFORMATION ON ITS OWN TRANSACTIONS AND EXPERIENCES.) ; (5) Understand, that you or any financial institution to whom it is submitted will retain this application whether or not it is approved, and that it is the applicant's responsibility to notify the creditor of any changes of name, address or employment. The financial institutions named below may be requested to purchase a sales finance contract written, or to be written, in connection with your purchase. You are notified pursuant to the Fair Credit Reporting Act, that your application may be submitted to them or to other financial institutions.

Financial Institutions

Bank Of The West

2527 Camino Ramon

San Ramon, CA 94583

Bank Of America N.A.
P.O.Box 2759
Jacksonville, FL 32203

US Bank N.A.
P.O. Box 3427
Oshkosh, WI 54930

Marine One Financial
500 North Akard Suite 1900
Dallas, TX 75201

Merrick Bank

P.O. Box 1500

Draper, UT 84020

Medallion Bank 

1100 East 6600 South Ste 510

Salt Lake City, UT 84121

LBS Financial Credit Union

PO Box 4860

Long Beach, CA 90804

Alliant Credit Union

PO Box 255388

Sacramento, CA 95865

Ally Financial

PO Box 674

Minneapolis, MN 55440

Equity Finance Group

1071 N Tustin Ave Ste:105

Anaheim, CA 92807

By Typing My Name Below, I Authorize Family RV USA to Run My Credit

Applicant Name:
Co-Applicant Name:
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