CneerRVInc
KZ Forest River Keystone
570.224.8606 or 800.881.6337
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Please fill out this online application and someone will contact you. We do not collect social security and DOB on this form for sercurity reasons. If you would like to fill out a paper form, please give us a call.
Primary Applicant

U.S. Citizen Yes . No
First Name
 Mi
 Last Name
No. of Dependents
 Ages of Dependents
 Driver's License
 State
Present Street Address
(Do not use P.O. Box)
 City
 St
 Zip
 How Long?
Previous Street Address
(Do not use P.O. Box)
 City
 St
 Zip
 How Long?
Home Phone
 Work Phone & Extension
Present Employer
 Street Address
 City
 St
 Zip
Current Occupation
 Position/Dept.
 Supervisor
 How Long?
 Monthly
Salary
Source of other monthly income:
Property, Investments, Social Security, CD's, etc.
 Other
Income
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.
Alimony, child support, separate maintenance received under:
Court Order Written Agreement Verbal Understanding
Alimony
Spouse


If not married to each other, please complete separate application
U.S. Citizen . Yes No
First Name
 MI
 Last Name
No. of Dependents
 Ages of Dependents
 Driver's License
 State
 Date of Birth
Present Street Address
(Do not use P.O. Box)
 City
 St
 Zip
 How Long?
Previous Street Address
(Do not use P.O. Box)
 City
 St
 Zip
 How long?
Home Phone
 Work Phone & Extension
Present Employer
 Street Address
 City
 St
 Zip
Current Occupation
 Position/Dept.
 Supervisor
 How Long?
 Monthly
Salary
Source of other monthly income:
Property, Investments, Social Security, CD's, etc.
 Other
Income
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.
Alimony, child support, separate maintenance received under:
Court Order Written Agreement Verbal Understanding
Alimony

Debts and Obligations
First Mortgage or Rent (Name & Address of Leinholder)
 Market
Value
 Original
Amount
 Current
Balance
 Monthly
Payment
Other Debts (Name & Address of Leinholder)
Credit Cards
Visa
Sears		 MasterCard
Penney's		 Discover Amer Ex Gas Cards Total
Balances 		Total
Payments
Other Creditors

Balance

Payment

Other Assets

 

 Loan Balance

Current Value

Have you ever had any property repossessed?
Yes No 		Military Reserve ?
Yes No 		Active?
Yes 		Active?
No
Have you ever filed for bankruptcy or is a bankruptcy proceeding in progress or expected?
Yes No 		Do you have any law suits pending against you?
Yes No

Personal References

Nearest Relative Name (Not Living With You)
 Phone No.
          Relative Address (Street, City, State, Zip)
          		Relationship
Personal Reference (Not Related)
 Phone No.
          Personal Reference Address (Street, City, State, Zip)
         

In the following sentence, the applicant/co-applicant is referred to as "I" and the creditor is referred to as "you and your".  I, the undersigned (1) make the above representations, which are certified correct, for the purpose of securing credit; (2) authorize financial institutions to obtain consumer credit reports on me periodically and to gather employment history as they consider necessary and appropriate; (3) authorize your affiliates to obtain consumer credit reports on me; (4) authorize the Dealer's Assignee to share and use information about me, including information on my application, with other entities that are related to it by common ownership or affiliated with it by common control, and (5) understand, that you or any financial institution to whom it is submitted will retain this application whether or not it is approved, and that it is the applicant's responsibility to notify the creditor of any changes of name, address or employment.

If you Acknowledge and Agree to All the Conditions and Terms of this Credit Application
Check Here and type your initials     (initials)

Your e-mail address


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