Credit Application

PRODUCT TYPE

SYSTEM SIZE (KW)

TOTAL INCENTIVES $

TOTAL AMOUNT REQUESTED $

IS THIS A MOBILE HOME?

YES

NO

DOWN PAYMENT $

CHECK APPLICABLE BOX

INDIVIDUAL CREDIT (Applicant Only)

JOINT CREDIT

(A) APPLICANT INFORMATION

PRINT FULL NAME

DOS

SSN

STREET ADDRESS

CITY

STATE

ZIP CODE

HOW LONG?

HOME PHONE

CELL PHONE

NAME ON DEED

MONTHLY RENT/MORTGAGE PWT

EMAIL ADDRESS

PREVIOUS ADDRESS (If less than 2 years at current address)

CURRENT EMPLOYER/RETIRED OR SELF EMPLOYED

CURRENT EMPLOYER'S ADDRESS

GROSS MONTHLY SALARY

WORK PHONE

OCCUPATION/JOB TITLE

HOW LONG?

PREVIOUS EMPLOYER (If less than 2 years on current job)

HOW LONG?

Documents Required:

CURRENT UTILITY BILL (PHOTO)

CURRENT UTILITY BILL (FILES)

COPY OF CURRENT ID (PHOTO)

COPY OF CURRENT ID (FILES)

FAIR CREDIT REPORTING ACT TO CONSUMER

THIS WILL ADVISE YOU THAT YOUR RETAIL INSTALLMENT SALES CONTRACT AND BUYER'S APPLICATION FOR SECURED DEBT WILL BE SUBMITTED TO FINANCIAL INSTITUTIONS AND THEIR AFFILIATES FOR PURCHASE AND CONSIDERATION AS TO WHETHER YOU MEET THEIR CREDIT REQUIREMENTS.

THE UNDERSIGNED FURTHER AUTHORIZES THESE FINANCIAL INSTITUTIONS AND THEIR AFFILIATES TO OBTAIN SUCH INFORMATION THAT THEY MAY REQUIRE IN ORDER TO VERIFY INFORMATION RELATIVE TO THIS REQUEST INCLUDING CONTACTING SPOUSES TO VERIFY SPOUSE RELATED INFORMATION.

I CERTIFY THAT ALL INFORMATION GIVEN BY ME ON THIS APPLICATION IS COMPLETE AND ACCURATE. I GIVE MY PERMISSION FOR ANY FINANCIAL INSTITUTION WHICH WILL REVIEW THIS CREDIT APPLICATION, TO INVESTIGATE MY CREDIT AND EMPLOYMENT HISTORY, AND TO ANSWER QUESTIONS ABOUT THEIR CREDIT EXPERIENCE WITH ME INCLUDING BUT NOT LIMITED TO LATE PAYMENTS, MISSED PAYMENTS OR OTHER DEFAULTS, AND THIS INFORMATION MAY BE REPORTED IN MY CREDIT REPORT, AS WELL AS FOR ANY UPDATE, RENEWAL OR EXTENSION OF THE FINANCING RECEIVED. THIS APPLICATION MAY BE SUBMITTED TO MORE THAN ONE POTENTIAL LENDER.

Applicant Signature Required

Date

Please check one

ID

DL

#

State

Issued

Expired

(B) JOINT APPLICANT INFORMATION

PRINT FULL NAME

DOS

SSN

STREET ADDRESS

CITY

STATE

ZIP CODE

HOW LONG?

HOME PHONE

CELL PHONE

NAME ON DEED

MONTHLY RENT/MORTGAGE PWT

EMAIL ADDRESS

PREVIOUS ADDRESS (If less than 2 years at current address)

CURRENT EMPLOYER/RETIRED OR SELF EMPLOYED

CURRENT EMPLOYER'S ADDRESS

GROSS MONTHLY SALARY

WORK PHONE

OCCUPATION/JOB TITLE

HOW LONG?

PREVIOUS EMPLOYER (If less than 2 years on current job)

HOW LONG?

Documents Required:

CURRENT UTILITY BILL (PHOTO)

CURRENT UTILITY BILL (FILES)

COPY OF CURRENT ID (PHOTO)

COPY OF CURRENT ID (FILES)

FAIR CREDIT REPORTING ACT TO CONSUMER

THIS WILL ADVISE YOU THAT YOUR RETAIL INSTALLMENT SALES CONTRACT AND BUYER'S APPLICATION FOR SECURED DEBT WILL BE SUBMITTED TO FINANCIAL INSTITUTIONS AND THEIR AFFILIATES FOR PURCHASE AND CONSIDERATION AS TO WHETHER YOU MEET THEIR CREDIT REQUIREMENTS.

THE UNDERSIGNED FURTHER AUTHORIZES THESE FINANCIAL INSTITUTIONS AND THEIR AFFILIATES TO OBTAIN SUCH INFORMATION THAT THEY MAY REQUIRE IN ORDER TO VERIFY INFORMATION RELATIVE TO THIS REQUEST INCLUDING CONTACTING SPOUSES TO VERIFY SPOUSE RELATED INFORMATION.

I CERTIFY THAT ALL INFORMATION GIVEN BY ME ON THIS APPLICATION IS COMPLETE AND ACCURATE. I GIVE MY PERMISSION FOR ANY FINANCIAL INSTITUTION WHICH WILL REVIEW THIS CREDIT APPLICATION, TO INVESTIGATE MY CREDIT AND EMPLOYMENT HISTORY, AND TO ANSWER QUESTIONS ABOUT THEIR CREDIT EXPERIENCE WITH ME INCLUDING BUT NOT LIMITED TO LATE PAYMENTS, MISSED PAYMENTS OR OTHER DEFAULTS, AND THIS INFORMATION MAY BE REPORTED IN MY CREDIT REPORT, AS WELL AS FOR ANY UPDATE, RENEWAL OR EXTENSION OF THE FINANCING RECEIVED. THIS APPLICATION MAY BE SUBMITTED TO MORE THAN ONE POTENTIAL LENDER.

Applicant Signature Required

Date

Please check one

ID

DL

#

State

Issued

Expired

OTHER INCOME NOTE: Alimony, child support, or separate maintenance incomes do not have to be revealed unless the applicant wishes to have such sources considered as a basis for repayment of the requested credit amount.

OTHER INCOME 1 - GROSS MONTHLY

OTHER INCOME 1 - SOURCE

OTHER INCOME 2 - GROSS MONTHLY

OTHER INCOME 2 - SOURCE

REFERENCE 1 - NAME

REFERENCE 1 - PHONE

REFERENCE 1 - ADDRESS

REFERENCE 1 - RELATIONSHIP

REFERENCE 2 - NAME

REFERENCE 2 - PHONE

REFERENCE 2 - ADDRESS

REFERENCE 2 - RELATIONSHIP

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Click the button below only if you have verified that the data you entered is correct.

ERUS ENERGY CREDIT APPLICATION