Secure Finance Application STATEMENT OF CONSENT * I certify that the information provided by me is correct. I also understand that you will be checking with credit reporting agencies. I authorize an investigation of my credit and employment history and the release of information about my credit experience. Please initial below to indicate that you have received a copy of our Privacy Notice and agree to all of the above. YOUR CREDIT APPLICATION IS GOING THROUGH A SECURE WEBSITE AND YOUR IDENTITY IS SAFE VEHICLE INFORMATION * Type Forklift Scissor Lift Compaction Equipment Condition * New Used Year * 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 Make * Model * Down Payment * $ YOUR CONTACT INFORMATION * First Name Last Name Drivers License Number * Work Phone * (###) ### #### Home Phone * (###) ### #### Email Social Security Number * ** This is a secure form. We will never share your information. Marital Status Married Not Married Sex Male Female Date of Birth PHYSICAL ADDRESS INFORMATION * Address 1 Address 2 City State/Province Zip/Postal Code Country HOUSING INFORMATION Do you own or rent your home? Own Rent Other Landlord / Mortgage Holder Monthly Rent / Mortgage Amount $ Mortgage Balance * $ Time at Current Residence * BANK INFORMATION * Name of Bank Account Types Name of Bank Account Types PREVIOUS RESIDENCE (If less than 5 years at Current Residence...) Address 1 Address 2 City State/Province Zip/Postal Code Country How long at Previous Residence EMPLOYER INFORMATION * Occupation Employer Name * Employer Address * Employer City * Employer State * Employer Zip * Employer Phone * (###) ### #### Salary (annual gross) $ Time at Employer Type of Employment Full time Part time Other Income $ Other Income Frequency Additional Comments Please include any information that you feel may help us process your application. REFERENCES First Name Last Name Phone (###) ### #### City State REFERENCES Phone (###) ### #### City State REFERENCES Phone (###) ### #### City State Thank you!
