CREDIT APPLICATION FORM
Please fill out and print the form below. After the form is printed, please sign and date it at the bottom.
Please either fax it to us at 1-706-232-1531, or mail it to the following address: Rhinehart Equipment
Co. PO Box 1701, Rome, GA 30162-1701. If you cannot print this form, please contact us and we will
fax or mail you a form.
Please note: Click the SUBMIT button at the bottom of the page to send us your information over the
internet and contact a sales representative for pricing on the equipment you are interested in
purchasing.
|
Are you financing in your name or the name of your company?
If at current address less than 3 years, prior address:
,
PREVIOUS EMPLOYER
INFORMATION (if at Current Employer
less than 2 years)
BUSINESS OR AGRICULTURAL INFORMATION
If you are self employed, what is your business?
Business Activity:
Equipment purchased for:
No
CO-APPLICANT INFORMATION
(Individual Co-Applicant required on
Partnership, Corporation & LLC loans)
Are you a U.S. Citizen?
Have you ever filed bankruptcy?
Do you have any current judgements
against you?
REFERENCES
Nearest relative not living with you
Name
Address
City, State, Zip Telephone Number Relationship
Bank Information
Name Address
City, State, Zip Telephone Number
Person to contact
Account Number
LandLord/Mortage Information
Name Address
City, State, Zip Telephone Number
Person to contact
Account Number
Other Lender
Name Address
City, State, Zip Telephone Number
Person to contact
Account Number
--------------------------------------------------------------------------------
NOTICE: The Federal Equal Opportunity Act prohibits creditors from discriminating against credit applicants on
the basis of race, color, religion, natural origin, sex, marital status, age (provided the applicant has the capacity
to enter into a binding contract); because all or part of the applicant's income derives from any public
assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit
Protection Act. The federal agency that administers compliance with this law concerning the creditor is the
Federal Trade Commission, Equal Credit Opportunity, Washington, D.C. 20580.
Notice To New York Residents: A consumer credit report may be requested in connection with this application
or in connection with updates, renewals or extensions of any credit granted as a result as a result of this
application. If you subsequently ask for this information, you will be informed whether or not such a report was
requested and, if so, the name and address of the agency that furnished the report.
Notice To Ohio Residents: The Ohio laws against discrimination require that all creditors make credit equally
available to all credit worthy customers, and that credit reporting agencies maintain separate credit histories on
each individual upon request. The Ohio civil rights commission administers compliance with this law.
Notice To Utah Residents: As required by Utah law, you are hereby notified that a negative credit report
reflecting on your credit record may be submitted to a credit reporting agency if you fail to fulfill the terms of
your credit obligations.
Notice To Married Wisconsin Residents: Wisconsin law provides that no agreement, unilateral statement or
court decree relating to marital property shall adversely affect a creditor's interest, unless prior to the time
credit is granted the creditor is furnished a copy of the agreement, statement or decree or has actual
knowledge of the adverse provision. You must indicate the name of your spouse on the Installation Contract,
and the address if different from yours.
Notice To Maine Residents: If this application is approved by the creditor, you will be required to obtain and
maintain physical damage insurance on the collateral securing the debt. You have the right of free choice in the
selection of the agent and insurer through or by which the insurance is placed. "NOTICE": Consumer reports
(credit reports) may be obtained in connection with this application. If you request, 1) you will be informed
whether or not consumer reports were obtained; and 2) if reports were obtained, you will be informed of the
name and address of the consumer reporting agencies (credit bureaus) that furnished the reports.
For the purposes of obtaining credit, I (we) certify to Rhinehart Equipment Company and its financial
institution(s) (hereafter referred to as "Rhinehart" all information in this statement is true and correct and
accurately describes my (our) financial condition as of the date shown, and that there have been no material
changes since then. I (we) grant permission to Rhinehart to verify all information in this statement and to
provide any information requested by my (our) other creditors. I also grant Rhinehart permission to obtain a
credit report on me in connection with this transaction for all legitimate purposes. Such purposes include
assisting in making a credit decision, reviewing my account, and assisting in taking collection activity. I (we) also
grant permission to those creditors to provide all information requested by Rhinehart. I (we) also authorize
Rhinehart to share all the foregoing information with its affiliates. I (we) release and waive all claims against
Rhinehart and my (our) other creditors for all acts or omissions which occur in verifying the above information.
Applicant Signature ______________________________________ Date ______________________
Title (for Corporations, Partnerships, and LLCs) _________________________________
Co-Applicant Signature ______________________________________ Date ______________________
Title (for Corporations, Partnerships, and LLCs) _________________________________
Please make sure that all information is correct before clicking the Submit button. By clicking the button you
certify that all information is correct and up to date.