CREDIT APPLICATION The P.O.W.E. F.L.L.C. Registration: Home:
Name:
_______________________________________Date: _____________________________________________
Co-Applicant/
Spouse: __________________________________________________________________________________
Street Address:
_________________________________________________________________________________________
Years There:
_______________________________________Own: _________ Rent:_______ Acres:_________________
Mailing Address:-
_________________________________________________________________________________________
City, State, Zip:
_________________________________________________________________________________________
Home #:
_______________________________________Work #: __________________ Cell #: __________________
EMail:
_______________________________________Web Site __________________________________________
Previous Address:
_______________________________________Years There:_______________________________________
City, State, Zip:
_________________________________________________________________________________________
How Much Do You Want To Charge?
$______________________________________For What: _________________________________________
APPLICANT: Last Four Digits
Birth date: ______________________________SS#: ____________________________________________
City
_______________________________________State: ____________________________________________
Years There:
_______________________________________Salary: _____________Per:__________________________
City, State, Zip:
_________________________________________________________________________________________
Phone #:
_______________________________________Fax:______________________________________________
Previous Employer:
_______________________________________Position: __________________________________________
Yrs There:
_______________________________________Salary: ____________ Per: ___________________________
Employer Address:
_________________________________________________________________________________________
City, State, Zip:
_________________________________________________________________________________________
Phone #:
_______________________________________Fax: ______________________________________________
Other Income:
_______________________________________Source: __________________________________________
CO-APPLICANT:
Birth date: ______________________________SS#: _____________________________________________
DL#:
_______________________________________State: ____________________________________________
Employer:
_______________________________________Position:___________________________________________
Years There:
_______________________________________Salary: ___________Per:_____________________________
Employer Address:
_________________________________________________________________________________________
City, State, Zip:
_________________________________________________________________________________________
Phone #:
_______________________________________Fax:_______________________________________________
Previous Employer:
_______________________________________Position: __________________________________________
Years There:
_______________________________________Salary: __________ Per: _____________________________
Phone #:
_______________________________________Fax: ______________________________________________
Other Income:
_______________________________________Source: ___________________________________________
Do you have an account with us now?
_________________________________________________________________________________________
If yes, how long when was it established?
_________________________________________________________________________________________
Name on the account:
_________________________________________________________________________________________
BANK REFERENCES:
Name of Bank:
_______________________________________Account #: _________________________________________
Address:
_________________________________________________________________________________________
Phone #:
_______________________________________Fax #: ____________________________________________
Name of Bank:
_______________________________________Account #: _________________________________________
Address:
_________________________________________________________________________________________
Phone #:
_______________________________________Fax #: _____________________________________________
CREDIT REFERENCES:
1. Name:
_______________________________________Account #: _________________________________________
Address:
________________________________________________________________________________________
2. Name:
_______________________________________Account #: _________________________________________
Address:
________________________________________________________________________________________
Phone #:
_______________________________________Fax #: _____________________________________________
3. Name:
_______________________________________Account #: _________________________________________
Address:
________________________________________________________________________________________
Phone #:
_______________________________________Fax #: _____________________________________________
4. Name:
_______________________________________Account #: _________________________________________
Address:
________________________________________________________________________________________
Phone #:
_______________________________________Fax #: _____________________________________________
Have you ever had a judgment against you or filed bankruptcy?
________________________________________________________________________________________
If yes, Please Explain:
________________________________________________________________________________________
Nearest Relative not living with you:
Name: _________________________________Relationship: ______________________________________
Phone #:
________________________________________________________________________________________
Address:
________________________________________________________________________________________
City, State, Zip:
________________________________________________________________________________________
Persons allowed to charge on my account:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Everything that I have stated in this application is correct to the best of my knowledge. I
understand that you will retain this application whether or not it is approved. You are authorized
to check my credit and employment history and to answer questions about your credit experience
with me. I also understand the credit policy of The P/O/W.E. Co. whereas all statements are due and
payable on the 15th of each month following purchase. I also agree to pay a FINANCE CHARGE
on all statement balances or unpaid portion of statement balances unpaid by the following DUE DATE.
A finance charge will be assessed on the unpaid past due balance at a rate that has been specified.
If an attorney is required for collection of any amounts owing, I will pay reasonable attorney fees
and court costs as permitted by law. I further understand that The P.O.W.E. Co. has the right to
limit or terminate this credit agreement without prior notice to me._________________________
Applicant Signature
_______________________________________________________________/___/___/__________________
Co-Applicant
Signature
______________________________________________________________/___/___/___________________
Date
AUTHORIZATION FOR RELEASE OF INFORMATION
I, the undersigned, hereby authorize a release of financial information on me and / or my business as
requested by the Credit Department of The P.O.W.E. Co.
The P.O.W.E. Co. will guard the confidentiality of the information and will use it in considering my
application for credit or to update financial information on my account.
A photocopy of this Authorization for Release of Information shall be the same as an original for all
purposes whatsoever.
________________________________________________________________________________________
Signature of Applicant:
________________________________________________________________________________________
Printed:
________________________________________________________________________________________
Date:
________________________________________________________________________________________
Signature of Co-Applicant:
________________________________________________________________________________________
Printed:
__________________________ ______________________________________________________________
Date:
________________________________________________________________________________________
