Country RV - of Chippewa Falls, Wisconsin is a full service recreational vehicle dealership providing sales, service and consignments of new & used RV

Country RV Credit Application

Consumer Credit Application

In order for your credit application to be properly evaluated, it is essential that all of the following questions be answered carefully and completely to the best of your ability.

Privacy & Security Notice

Country RV has a strong commitment to the privacy and security of our consumers and other visitors to our web site. Any information collected will be used ONLY to evaluate your consumer credit application and will NOT be sold, traded or given to any outside parties.

General Information
Dealer
Dealer Phone
Dealer Fax
Dealer Contact
Application Date
     

SECTION A. Information Regarding Individual Applicant:

Applicant Information:
Last Name First Name Middle Initial
Birth Date Social Security Number
Phone Cell Phone Email Address
Driver's License State Driver's License Number
  Number of Dependents  
Current Address
Address Line #1
Address Line #2
City State Zip Code
  How Long at this address? Years Months
Previous Address (To cover 5 years of residence)
Address Line #1
Address Line #2
City State Zip Code
How Long at this address?   Years Months
Present Employer
Present Employer
Present Employer Phone
Position
Address Line #1
Address Line #2
City State Zip Code
How Long at present employer?   Years Months
Previous Employer (To cover 5 year history)
Previous Employer
Previous Employer Phone
Position
Address Line #1
Address Line #2
City State Zip Code
How Long at previous employer?   Years Months
Nearest relative not living with applicant
Nearest Relative
Nearest Relative Phone
Address Line #1
Address Line #2
City State Zip Code
Applicant's Income
  Applicant's gross monthly income from employment:
Alimony, child support or maintenance income need not be revealed if
you do not wish to have it considered as a basis for repaying this obligation.
Applicant's other income source Applicant's other income amount:
  Applicant's total monthly income:

SECTION B. Information Regarding Joint Applicant or Other Party

(Complete only if: for joint credit, for individual credit relying on income or assets from other sources.)

Joint Applicant Information:
Last Name First Name Middle Initial
Birth Date Social Security Number
Phone Cell Phone Email Address
Driver's License State Driver's License Number
  Number of Dependents  
Joint Applicant Current Address (if different from applicant)
Address Line #1
Address Line #2
City State Zip Code
  How Long at this address? Years Months
Joint Applicant Previous Address (To cover 5 years of residence)
Address Line #1
Address Line #2
City State Zip Code
How Long at this address?   Years Months
Joint Applicant Present Employer
Present Employer
Present Employer Phone
Position
Address Line #1
Address Line #2
City State Zip Code
How Long at present employer?   Years Months
Joint Applicant Previous Employer (To cover 5 year history)
Previous Employer
Previous Employer Phone
Position
Address Line #1
Address Line #2
City State Zip Code
How Long at previous employer?   Years Months
Joint Applicant Nearest relative not living with applicant
Nearest Relative
Nearest Relative Phone
Address Line #1
Address Line #2
City State Zip Code
Joint Applicant's Income
  Applicant's gross monthly income from employment:
Alimony, child support or maintenance income need not be revealed if
you do not wish to have it considered as a basis for repaying this obligation.
Applicant's other income source Applicant's other income amount
  Applicant's total monthly income

SECTION C. Asset and Debt Information

Landlord or Mortgage Information
Do you rent or own your home?  
Landlord or Mortgage Holder
Current Value of Your Home
Mortgage Balance
Monthly Payment or Rent
Second Mortgage Balance
Second Mortgage Payment
Have you ever had any property repossessed?  
Do you have any pending lawsuits against you?  
Have you ever filed bankruptcy?  
Military Reserve?  
Military Reserve?  
Additional Comments or Information
Read Carefully Before Submitting

 

In submitting this application to Country RV seeking an extension of secured credit, I warrant and represent to Country RV that the information furnished above is truthful, accurate and supplied voluntarily. By accepting this online submission form I authorize Country RV and their credit providers or agents to, 1)check my credit and employment histories and bank and personal references; 2) to obtain consumer reports from consumer reporting agencies in considering this application and subsequently in connection with any update, renewal, extension of credit, review or collection of their account (if credit is granted); 3) to report to others their credit experience with Country RV and their credit providers and to answer questions about their experience with Country RV and their credit providers (in accordance with applicable law) and; 4) to keep this application whether or not it is approved. I agree to notify the creditor of any change of information provided above.

 

 

Review ALL Above Information & Submit to Country RV for Consideration

 

 
 
   
     

Thank you for your time and interest in Country RV Recreational Vehicles.