LOAN APPLICATION
Dealer Name ROTHWELL MARINE
Telephone Number 870-777-6180
APPLICANT INFORMATION
NAME (First, Middle, Last
Date of Birth
Social Security Number
Num. of Dependents
ADDRESS (Street) (City) (State) (Zip)
Telephone Number
Name and Address of Current Employer
Position
Time with Employer: Yrs / Mths
Business Phone
Monthly Gross Income $
Other Monthly Income $ Explain Source
NAME (First, Middle, Last)
Date of Birth
Social Security Number
Home Phone Number
ADDRESS (Street) (City) (State) (Zip)
Time at Address Yrs / Mths
Monthly Gross Income $
Name and Address of Current Employer
Position
Time w / Employer Yrs/Mths
Business Phone
DESCRIPTION OF GOODS BEING PURCHASED
ITEM
New or Used
YEAR
MANUFACTURER
MODEL
BOAT
MOTOR
TRAILER
Sale Price $
Down Payment if any $
YEAR
MANUFACTURER
MODEL
TRADE-IN
I hereby affirm that the foregoing information is true and correct and made for the purpose of
obtaining credit. I authorize you to obtain additional information from each source(s) and each source is hereby authorized to provide you with such information. I also grant you permission to obtain a credit report
on me for all legitimate purposes in connection with this transaction. Such purposes include assisting in making a credit decision, reviewing my account and assisting in taking collection activity. I authorize you
to share all the foregoing information with the Lender and it's subsidiaries. This application, in any event, shall be and remain the property of the Lender, and is subject to the completion and acceptance of
additional credit application documents proper to any approved extension of credit.
I Agree
Applicants Name
E-Mail Address
I Agree
Co-Applicants Name
