Plano Kawasaki Suzuki
Credit Application
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If you plan on submitting this application with a spouse or co-applicant, please remember to also complete section (B) CO-APPLICANT'S INFORMATION and EMPLOYMENT.
 
TEXT IN PURPLE DENOTES A REQUIRED FIELD
 
(A)     A P P L I C A N T 'S     I N F O R M A T I O N
 
Vehicle Make Pick one.
Vehicle Model / Size/ CCs   Vulcan / 1500 Classic
Full Name (Last, First Middle) Racer, Speed E
Birth Date (Month/Day/Year) 03/20/1970
Social Security Number ###-##-####
Driver's License Number  
Dependents Including Self  
Marital Status U = Single, Divorced, Widowed
Present Street Address "At the track" is not an address
City, State, Zip Code Speedtown, Texas, 75205
How Long at Present Address # Years, # Months
Home Phone Number (###) ###-####
Residential Status

If Other, please explain below

Other Residential Status Alien space ship?
Monthly Rent / Mortgage Pmt  
Landlord / Mortgage Holder  
Landlord / Mtg Holder Phone # (###) ###-####
Balance of Mortgage  
Mortgage Account #  
Previous Address* *If less than 2 yrs. at present.
Previous City, State, Zip Code  
Closest Living Relative  
Relative's Phone # (###) ###-####
Any Bankruptcy (Yes, No) Yes   No If yes, include date below.
Bankruptcy Date 11/18/1990
U.S. Citizen (Yes, No) Yes   No  
     
Did you visit our shop? Yes   No  
If yes, who did you speak to?  
     
(A)     A P P L I C A N T 'S     E M P L O Y M E N T
 
Employer's Name  
Employer's City, State  
Employer's Business  
Supervisor's Name  
Job Title / Occupation  
Self Employed (Yes, No) Yes   No  
Hire Date Month/Year 10/97
Salary Gross Per... / Per Hour, Week, Month, Year
Part Time or Full Time Part   Full Part <= 25hrs, Full >25hrs
Work Phone # (###) ###-####
Employed from When to When  to  Month/Year 01/96 to 12/98
Previous Employer * * If less than 2 yrs. At present.
Previous Employer's City, State Dallas, TX
Previous Employer's Phone # (###) ###-####
Source of Other Income*  
Other Income Monthly Amount  
     
* Other Income Request: Alimony, clild support, or separate maintenance incomes do not have to be revealed unless the applicant wishes to have such sources considered as basis for repayment or requested credit.
 
Fair Credit Reporting Act Notice to Consumer


THIS WILL ADVISE YOU THAT YOUR RETAIL INSTALLMENT CONTRACT AND CREDIT APPLICATION WILL BE SUBMITTED TO PLANO KAWASUKI SUZUKI, FOR PURCHASE AND CONSIDERATION AS TO WHETHER YOU MEET THEIR CREDIT REQUIREMENTS.

Notice: TO MAINE RESIDENTS. Consumer reports (credit reports) may be obtained in connection with this application. If you request, 1) You will be informed whether or not consumer reports were obtained; and 2) If reports were obtained, you will be informed of the name and address of the consumer reporting agencies (credit bureaus) that furnished the reports.

Notice: TO NEW YORK RESIDENTS.Plano Kawasaki Suzuki may obtain a consumer report on you in connection with your credit application. Upon request by you, Plano Kawasaki Suzuki will tell you whether or not a consumer report was obtained and the name and address of the consumer reporting agency that furnished the report.

Notice: TO OHIO RESIDENTS. The Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law.

Notice: TO MARRIED APPLICANTS RESIDING IN WISCONSIN. No provision of any marital property agreement, unilateral statement under s.766.59 Wis. Stats., or court decree under s.766.70 adversely affects the interest of the creditor unless the creditor, prior to the time the credit is granted or an open-end credit plan is entered into, is furnished a copy of the agreement, statement or decree or has actual knowledge of the adverse provision.


ALL OF THE STATEMENTS MADE IN THIS APPLICATION ARE TRUE AND CORRECT AND ARE MADE FOR THE PURPOSE OF OBTAINING CREDIT. YOU ARE AUTHORIZED TO INVESTIGATE MY CREDIT RECORD, TO VERIFY MY CREDIT, EMPLOYMENT AND INCOME REFERENCES AND TO OBTAIN SUCH OTHER INFORMATION AS YOU DEEM NECESSARY AND TO GIVE CREDIT REPORTING AGENCIES AND OTHERS INFORMATION REGARDING YOUR CREDIT EXPERIENCE WITH ME.


Authorized By


E-mail Address


Authorization Date
 


 
 
REMEMBER: If you plan on submitting this application with a spouse or co-applicant, please complete the following section (B) CO-APPLICANT'S INFORMATION and EMPLOYMENT.
 
(B)     C O - A P P L I C A N T 'S     I N F O R M A T I O N
 
Full Name (Last, First Middle) Racer, Zippy
Birth Date (Month/Day/Year) 03/20/1970
Social Security Number ###-##-####
Dependents Including Self  
Marital Status U = Single, Divorced, Widowed
Present Street Address "At the track" is not an address
City, State, Zip Code Raceville, Texas, 75205
How Long at Present Address # Years, # Months
Home Phone Number (###) ###-####
Residential Status

If Other, please explain below

Other Residential Status Alien space ship?
Monthly Rent / Mortgage Pmt  
Landlord / Mortgage Holder  
Landlord / Mtg Holder Phone # (###) ###-####
Balance of Mortgage  
Mortgage Account #  
Previous Address* * If less than 2 yrs. At present.
Previous City, State, Zip Code  
Closest Living Relative  
Relative's Phone # (###) ###-####
Any Bankruptcy (Yes, No) Yes   No If yes, include date below.
Bankruptcy Date 11/18/1990
US Citizen (Yes, No) Yes   No  
     
(B)     C O - A P P L I C A N T 'S     E M P L O Y M E N T
 
Employer's Name  
Employer's City, State  
Employer's Business  
Supervisor's Name  
Job Title / Occupation  
Self Employed (Yes, No) Yes   No  
Hire Date Month/Year 10/97
Salary Gross Per... / Per Hour, Week, Month, Year
Part Time or Full Time Part   Full Part <= 25hrs, Full >25hrs
Work Phone # (###) ###-####
Employed from When to When  to  Month/Year 01/96 to 12/98
Previous Employer* * If less than 2 yrs. At present.
Previous Employer's City, State Dallas, TX
Previous Employer's Phone # (###) ###-####
Source of Other Income*  
Other Income Monthly Amount  
     
* Other Income Request: Alimony, clild support, or separate maintenance incomes do not have to be revealed unless the applicant wishes to have such sources considered as basis for repayment or requested credit.
 
Fair Credit Reporting Act Notice to Consumer


THIS WILL ADVISE YOU THAT YOUR RETAIL INSTALLMENT CONTRACT AND CREDIT APPLICATION WILL BE SUBMITTED TO PLANO KAWASUKI SUZUKI, FOR PURCHASE AND CONSIDERATION AS TO WHETHER YOU MEET THEIR CREDIT REQUIREMENTS.

Notice: TO MAINE RESIDENTS. Consumer reports (credit reports) may be obtained in connection with this application. If you request, 1) You will be informed whether or not consumer reports were obtained; and 2) If reports were obtained, you will be informed of the name and address of the consumer reporting agencies (credit bureaus) that furnished the reports.

Notice: TO NEW YORK RESIDENTS. Plano Kawasaki Suzuki may obtain a consumer report on you in connection with your credit application. Upon request by you, Plano Kawasaki Suzuki will tell you whether or not a consumer report was obtained and the name and address of the consumer reporting agency that furnished the report.

Notice: TO OHIO RESIDENTS. The Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law.

Notice: TO MARRIED APPLICANTS RESIDING IN WISCONSIN. No provision of any marital property agreement, unilateral statement under s.766.59 Wis. Stats., Or court decree under s.766.70 adversely affects the interest of the creditor unless the creditor, prior to the time the credit is granted or an open-end credit plan is entered into, is furnished a copy of the agreement, statement or decree or has actual knowledge of the adverse provision.


ALL OF THE STATEMENTS MADE IN THIS APPLICATION ARE TRUE AND CORRECT AND ARE MADE FOR THE PURPOSE OF OBTAINING CREDIT. YOU ARE AUTHORIZED TO INVESTIGATE MY CREDIT RECORD, TO VERIFY MY CREDIT, EMPLOYMENT AND INCOME REFERENCES AND TO OBTAIN SUCH OTHER INFORMATION AS YOU DEEM NECESSARY AND TO GIVE CREDIT REPORTING AGENCIES AND OTHERS INFORMATION REGARDING YOUR CREDIT EXPERIENCE WITH ME.


Co-Authorized By


E-mail Address


Co-Authorization Date
 


 

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