HOME

Online Credit Application

Island Lake
 Marine & Sports Inc.

5887 SW Frontage Rd.
 Ft. Collins, CO 80528
 970-225-6666
 970-225-3968 fax

Please fill this out and sign the form and fax it to 970-225-3968 before clicking on the submit button.

Credit Information:

Please check if own house.
Please check if rent house.
Please check if none of the above apply.
Please check if You've Ever Declared Bankruptcy.
First, Middle, Last Name
Driver's License Number & State
Driver's License Expiration Date
Marital Status
Number of Dependants
Date of Birth
Social Security Number
E-mail
Home Phone
Work Phone
FAX
Home Address
City
State
Zip
County
Time at Address (years, months)
Mortgage or Landlord Address
Mortgage Payment or Rent : monthly $
Previous Address If Less Than 2 Years
Time at Address (years, months)
Mortgage Company or Landlord Address
Name, Address and Phone # of Nearest Relative Not Living With You  
Employed By
Employer Address
Employer Phone
Occupation
Time Employed (years, months)
Alimony, child support, or separate income need may not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Gross Annual Income: $
Source of Other Income
Income From Other Sources: $
 

            Co-Applicant Information

Please check if own house.
Please check if rent house.
Please check if other.
Please check if You've Ever Declared Bankruptcy.
First, Middle, Last Name
Driver's License Number & State
Driver's License Expiration Date
Marital Status
Number of Dependants
Date of Birth
Social Security Number
E-mail
Home Phone
Work Phone
FAX
Home Address
City
State
Zip
County
Time at Address (years, months)
Mortgage or Landlord Address
Mortgage Payment or Rent : monthly $
Previous Address If Less Than 2 Years
Time at Address (years, months)
Mortgage Company or Landlord Address
Name, Address and Phone # of Nearest Relative Not Living With You  
Employed By
Employer Address
Employer Phone
Occupation
Time Employed (years, months)
Alimony, child support, or separate income need may not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Gross Annual Income: $
Source of Other Income
Income From Other Sources: $

            The following information pertains to both Applicant and Co-Applicant

 

Auto #1
Is the title clear?
Auto #2
Is the title clear?
Checking Account Number and Bank
Savings Account Number and Bank

 

Enter additional comments in the space provided below:

Enter insurance company, agent name, and telephone number below:

            
 

    By signing this application you promise that all information is true and complete.  You also promise that you have revealed any pending lawsuits or unpaid judgments against you.  You intend the seller and/or assignee to rely upon these promises in deciding whether to extend credit to you.  You authorize a full investigation of your credit record and your employment history.  You also authorize the seller and/or assignee to release information about your credit experience with them. 
Read special notices before signing.

 

    Applicant Signature______________________________  Date_________

 
    Co-Applicant Signature______________________________  Date_________

 

Please contact me as soon as possible regarding this matter.

 PRINT, SIGN AND FAX THIS SHEET TO 970-225-3968 BEFORE SUBMITTING

HOME

Industrial Design Technologies LLC
Copyright © 1999 [Island Lake Marine & Sports Inc]. All rights reserved.
Revised: April 20, 2009 .