Bill Ethridge Lincoln/Mercury

Bill Ethridge Lincoln-Mercury
On-line Credit Application

Please review our on-line Privacy Notice before proceeding.

Last Name
First Name
Middle Name
	Jr. Sr.
Date of Birth
Soc. Sec. No.
Driver's Lic. No.
State
Present Address
City
State
Zip Code
Email Address
Mailing Address (if different)
City
State
Zip Code
County
Phone?	Yes No
Phone Number
Own Home Outright
Buying Home
Living w/ Relatives
Leasing/Renting
Own/Buying Moblie Home
Lived there?	Yrs. Mos.
Name of Landlord or Mortgage Holder
Address
Rent or Mtge. Pmt. $
Previous Address (Street, City, State and Zip Code) If less than 2 yrs. at present address
Lived there?	Yrs.
Level of Education (Age Under 27 only)	1. 4 Yr. College Grad. 2. 2 Yr. College Grad. 3. Special Training 4. Some College High School Grad? Yes No
Current Employer Name
Applicant's Occupation (if military, state rank)
Work Phone Number
Gross Monthly Salary
Time on Job	Yrs. Mos.
*Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation. *
Source of Other Income
Other Income
Previous Employer's Name (if less than 5 yrs. at current employer)
City/State
Name of Bank
	1. Checking & Savings 2. Checking Only 3. Savings Only 4. No Account

Creditor's Name and City/State	Date Opened	Monthly Pmt. Amount	Unpaid Balance
1.
2.
3.
4.

Name and Address of Nearest Relatives/Friends Not in Household	Phone No.	Relationship
1.
2.

*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 further certifies that I have attained the age of majority. Applicant authorizes Bill Ethridge Lincoln/Mercury/Isuzu to check my credit and employment history and to provide and/or obtain information about credit experience with me.

** Applicants must be at least 18 years of age or older. **

I acknowledge by submitting this form that I have reviewed the on-line Privacy Notice and this application fully.

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