Special Needs Vehicles

Consumer Credit Application

This form requires a signature. Please fill out the form, press the submit button. Pressing the submit button will print out your records and send a copy of the information to us. After printing out the application, please fax it or mail it to us -- we cannot act on it until we receive the application form by fax or mail.

This credit application form is for those with any credit rating.

Instructions to Married Applicant(s): Answer all questions relating to you. Also answer all questions relating to your spouse unless you are separated and your spouse is not also applying for credit. All income and property will be assumed to be community property and all obligations will be assumed to be community debts unless "SP" is written next to the income, property, or debt.

Each applicant may apply for individual or joint credit, regardless of marital status.

This application is for:
If this application is for a joint credit with a separate person, who is this person?

Applicant
Last Name First Name
Middle Initial # in Family
U.S. Citizen? Date of Birth
Social Security Number Driver's License #
Marital Status Street Address
City State
Zip Code How Long at Current Address? (Yr/Mo)
Own or Rent? Rent per Month ($)
Current Mailing Address (if different) Previous Address (if less than 2 years)
Number of Years Employer's Name
How Long Employed? Employer's Address
Occupation Self-Employed?
Business Telephone Gross Monthly Income
Previous Employer's Name and Address How Long Employed?
Nearest Relative Not Living With You (Name) Relationship
Address Telephone
Other Net Monthly Income
(You do not have to reveal alimony, child support,
or separate maintenance income unless you
wish to have them considered for approving your application.)		 Source
$
Co-Applicant
Last Name First Name
Middle Initial Date of Birth
Social Security Number Relationship to Applicant
Driver's License # Street Address
City State
Zip Code Number of Years
Home Telephone Employer's Name
Employer's Address Occupation
Self-Employed? Business Telephone
How Long Employed? (Yr./Mo.) Gross Monthly Income
Asset and Liability Statement
Please note: Indicate by an asterisk (*) those liabilities or pledged assets which will be satisfied upon refinancing of subject property.
Description Cash or Market Value Creditor's Name Address Mo. Pmt/Mo. Left to Pay Unpaid Balance
Checking Name:
Savings Name:
Stocks and Bonds (No. and Description)
IRA Accts
Real Estate Owned
(Enter Market Value from Schedule of Real Estate Owned)
Vested Interest in Retirement Fund
Net Worth of Business Owned (Fax or Mail Financial Statement) Real Estate Loans:
(Enter Total Amount of Mortgages from
Schedule of Real Estate Owned)
Automobiles Owned (Make & Year)
Automobile Loan -- Lender Name
Other Assets (Itemize)
Other Assets (Itemize)
Total Assets (A)
Net Worth (A minus B)
Total Liabilities (B)

Notice for New York Residents --A consumer credit report may be requested in connection with this application or in connection with updates: renewals or extensions of any credit granted as a result of this application. If you subsequently ask for this information, you will be informed whether or not such a report was requested, and if so, the name and address of the agency that furnished the report.

Notice for Ohio Residents --The Ohio laws against discrimination require that all creditors make credit equally available to all credit worthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with the law.

Notice to Married Wisconsin Residents --Wisconsin Law provides that no agreement, unilateral statement, or court decree relating to marital property shall adversely affect a creditor's interest, unless prior to the time credit is granted the creditor is furnished a copy of the agreement, statement or decree or has actual knowledge of the adverse provision. You must indicate the name of your spouse on the installment contract, and the address if different from yours.

Notice to California and Utah Residents -- As required by law, you are hereby notified that a negative credit report reflecting on your creedit record may be submitted to a credit reporting agency if you fail to filfill the terms of your credit obligations.

Notice to Maine Residents -- If this application is approved by the creditor, you will be required to obtain and maintain physical damage insurance on the collateral securing the debt. You have the right of free choice in the selection of the agent and insurer through or by which the insurance is placed.

I hereby affirm that the forgoing information is true and correct and made for the purpose of obtaining credit. I authorize you to obtain additional information from any source(s) and each such sources is hereby authorized to provide you with such information. I also grant you permission to obtain a credit report on me for all legitimate purposes in connection with this transaction. Such purposes include assisting in making a credit decision, reviewing my account, and assisting you in taking collection activity. I also authorize you to share all the forgoing information with the Bank of the West and its subsidiaries. This application, in any event, shall be and remain in the property of the Lender, and is subject to the completion and acceptance of additional credit application documents prior to any approved extension of credit.

I hereby affirm that the foregoing information is true and correct and made for the purpose of obtaining credit. I authorize you to obtain additional information from any source(s) and each such sources is hereby authorized to provide you with such information. I also grant you permission to obtain a credit report on me for all legitimate purposes in connection with this transaction. Such purposes include assisting in making a credit decision, reviewing my account, and assisting in taking collection activity. I also authorize you to share all the foregoing information with the Bank of the West and its subsidiaries. This application, in any event, shall be and remain the property of the Lender, and is subject to the completion and acceptance of additional credit application documents prior to any approved extension of credit.

Applicant _________________ Date ____/____/____ Co-Applicant _________________ Date ____/____/____

Because this form requires a signature, you must print out the form. Sign the printed copy and mail it, fax it, or bring it in to our business. If this document is not signed, we cannot process it.

Press Print to print this form. After pressing Print, you will go to a confirmation screen where you will be prompted to e-mail the form information to us. Please do so, so that we may help you further.