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CREDIT APPLICATION

Person Entering Application

Product/Service Being Financed

Spanish Paperwork

Repayment Terms

Downpayment

Trade In

Tentative Installation Date

State Contract Written In:

Home Improvement Excludes Water Damage

Type of Credit

Selling price

Completion Payment

Amount Requested

Personal Information

ID Issue Date

Not Present On ID

ID Issue State:

Not Present On ID

First Name

Middle Initial

Last Name

Address 1

Address 2

City

State:

ZIP

Photo ID Type

SSN #

ID #

ID Expire Date

Not Present On ID

Home Phone

Cell Phone

Email

App. DOB

Type of Residence

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

Select the football