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CREDIT APPLICATION
Person Entering Application
Product/Service Being Financed
Spanish Paperwork
Repayment Terms
Select Term Months
12 months
18 months
24 months
36 months
48 months
60 months
72 months
Downpayment
Trade In
Tentative Installation Date
State Contract Written In:
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Home Improvement
Excludes Water Damage
Type of Credit
Closed-end
Open end
Selling price
Completion Payment
Amount Requested
Personal Information
ID Issue Date
Not Present On ID
ID Issue State:
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Other
Not Present On ID
First Name
Middle Initial
Last Name
Address 1
Address 2
City
State:
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Other
ZIP
Photo ID Type
Drivers License
Passport
Identity Card
Other
SSN #
ID #
ID Expire Date
Not Present On ID
Home Phone
Cell Phone
Email
App. DOB
Type of Residence
Rent
Own
Home Value
Mortgage/Rent Payment
Applicant's Financials
Self-Employed
Yes
No
App. Position
Time at Current Position
Retirement/SSI
Rentals
Investments
App. Employer
App. Employer Phone #
App. Gross Monthly Income
Other Income
I/We hereby authorize H-18, Inc. to submit my financing application to various financing entities (as needed) to obtain a credit decision. in order to assist me/us with financing. I further understand that once my application in submitted for credit I / we will receive the credit decision directly from the approving or denying bank within 7-10 business days. This notice may include; approval letter, denial letter, credit card or a shopping pass.
Applicant Signature
Date
Co-Applicant Signature
Date
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