EASTER’S INC
8100 Fairystone Park Hwy Bassett VA 24055
276-629-4777 or 276-627-8650
Fax: 276-629-1390
Credit Application
BUSINESS CONTACT
INORMATION
Full Name of Company:
________________________________________________________________
Address:
____________________________________________________________________________
Phone:
___________________Fax:_________________Email:_________________________________
Year Organized: ____________________________Person to
Contact: __________________________
You’re Name:
________________________________________________________________________
Title: ________________ Form of Organization:
____________________________________________
Federal I.D:____________________
Sole proprietorship: ____________________
Partnership:_____________ Corporation:_____________
PERSONAL GUARANTOR
Name:
_______________________________________________________________________________
Address:
_____________________________________________________________________________
Social Security: _______________________Date of birth:
__________________U.S. Citizen: ________
Telephone: _______________________________ Fax:
________________________________________
Cell phone number: _____________________________E-mail:
__________________________________
Bank name:
___________________________________________________________________________
Bank address:
_________________________________________________________________________
Phone:
________________________________________________________________________________
Mortgage with: _________________________________ Monthly
payment: _______________________
Employer: __________________________________ Position :
__________________________________
Address:
______________________________________________________________________________
Employer number: ___________________ How long:
__________________________________________
Additional income per month:
_____________________________________________________________
SPOUSE OR ADDITIONAL GUARANTON
Name:
________________________________________________________________________________
Address:
______________________________________________________________________________
Social Security: _______________________ Date of birth:
________________U.S. Citizen: __________
Telephone: _____________________________ Cell phone number:
_____________________________
Fax: ________________________________ Email :
__________________________________________
Social Security: ________________________ Date of birth:
___________________________________
Employer:
____________________________________________________________________________
Address:
_____________________________________________________________________________
Phone: ________________________________Additional income per
month: ______________________
Bank name:
__________________________________________________________________________
Bank Address:
________________________________________________________________________
Mortgage with: _______________________________________
Monthly payment: ________________
Primary Bank:
_________________________________________________________________________
Contact:
_____________________________________________________________________________
CREDIT
REFERENCES
Creditor:
_____________________________________________________________________________
Contact: ______________________________ Phone :
________________________________________
Creditor:
_____________________________________________________________________________
Contact: ______________________________ Phone :
________________________________________
Vehicle Information you are interested in
Year______ Make_______________ Model____________
Price wanting to spend_________________
Down payment______________________
FAIR CREDIT REPORTING ACT AUTHORIZATION
For the purpose of securing credit from you, I certify that
the above information is true and
complete to the best of my knowledge Applicant authorizes you to check my credit
and employment history
and to provide and / or obtain information about credit experience with
Easter's INC.
Applicant Signature:
_______________________________________________________Date :______
Joint Applicant Signature:
__________________________________________________Date:_______