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2010 POLARIS RZR
4 ROBBY GORDON
Credit Pre-Qualification
Applicant
Information
Name:
Email Address:
Date of Birth:
mm/dd/yyyy
Social Security:
999-99-9999
Home Phone:
Work Phone:
Driver's License:
Number:
Expiration Date:
State:
Have you every declared bankruptcy?
Address Information
Current Address:
Street:
City:
State:
Zip:
Owned
Rented
Monthly Payment or Rent:
How Long?:
Previous Address:
Street:
City:
State:
Zip:
Owned
Rented
Monthly Payment or Rent:
How Long?:
Employer Information
Current Employer:
Street:
How Long?:
City:
State:
Zip:
Phone:
Email:
Fax:
Position:
Salary
Hourly
Annual Income:
Previous Employer:
Street:
How Long?:
City:
State:
Zip:
Phone:
Email:
Fax:
Position:
Salary
Hourly
Annual Income:
Reference Information
Name of a relative not residing with you:
Street:
City:
State:
Zip:
Phone:
Relation:
Add Co-Applicant
Applicant
Credit Cards
Description:
Account Number:
Balance:
Monthly Payment:
Add Credit Card
Auto Loans
Description:
Account Number:
Balance:
Monthly Payment:
Add Auto Loan
Other Loans, Debts, or Obiligations
Description:
Account Number:
Balance:
Monthly Payment:
Add Other Debts or Loans
Mortgage Company
Add Mortgage
Other Assets or Sources of Income
Description:
Amount/Month or Value:
Add Income Source or Asset
Vehicle Interested In Buying
Year:
Make:
Model:
Price:
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Add Vehicle
Signatures
I authorize Sonoma Cycle to verify the information provided on this form as to my credit.
Signature of Applicant
Date:
Saturday, September 04, 2010
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