5649 University Ave NE Fridley, Minnesota Sales Direct 763-586-0000

Credit Application

Full Name:
Social Security Number:
Date of Birth:
Phone Number:
Street Address:
City: ,
Years and Months at residence:
Rent or own:
Monthly payment:
Previous address if less than 2 years
Previous Street Address:
Previous City: ,
Previous State:
Previous Zip:
Years and months at previous residence:
Gross Monthly Income:
Time on job (years and months):
Employer Phone:
Previous employer if less than 2 years
Time on previous job (years and months):
Previous Employer Phone:

Credit Report.
A credit report may be obtained in connection with this application, for extension of credit for which application was made. Upon request, I will be told if a credit report(s) was/were obtained, and given the name and address of the credit reporting agency(s) providing the report(s).
Credit Investigation.
I authorize the dealer/Lender(s) to start a credit investigation, including verification of employment and income history from state records including State Employment Security Agency records, based on the information voluntarily provided by me which is true and correct, and reflects all my current debts.
Do you agree to these terms?
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