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GENERAL APPLICANT INFORMATION Federal Tax I.D. or SS#:______________ Date of Birth:_____/____/_____ First Name:________________________ Middle Name:______________________ Last Name:________________________ Business Name:______________________________________________________________________ Street Address:_________________________ City:_______________ State:____ ZIP:__________ Home Telephone: (______)______-_________ Business Telephone: (______)______-_________ Yrs at Address: _____ Type of Residence: [ ] Own [ ] Rent [ ] Lease [ ] Board [ ] Other Please complete mailing address if different from street address above: Mailing address: ________________________ City:_______________ State:____ ZIP: ___________ If at address less than 3 years, please give previous address information: Yrs at previous address _____ Street Address:_________________________ City:_______________ State:____ ZIP:__________ CURRENT EMPLOYER INFORMATION: Employer Name: ______________________________________________________________________ Employer Address:_______________________ City:_______________ State:____ ZIP:__________ Work Telephone: (______)______-_________ Position: ____________________ Yrs at job: _____ Gross Monthly Salary $_______________ PREVIOUS EMPLOYER (If at present employer less than 2 years): Employer Name: ______________________________________________________________________ Employer Address:_______________________ City:_______________ State:____ ZIP:__________ Work Telephone: (______)______-_________ Position: _____________________ Yrs on job: ____ Gross Monthly Salary $_______________ BUSINESS OR AGRICULTURAL INFORMATION: If you are self employed, what is your type of business? [ ] Proprietorship [ ] Partnership [ ] Corporation Business Activity: [ ] Farming [ ] Plumbing/Sewer [ ] Excavating [ ] Sand/Gravel [ ] Rental [ ] Rental/Purchase [ ] Landscaping/Mowing [ ] Construction [ ] Golf Course [ ] Other [ ] Part time Number of years farming: ____ Total number of Acres:______ Type of livestock or crops:______________ Est. Annual Farm Income: $___________ Market Date: _____/_____/_______ OTHER
INCOME: (Alimony, Child support or separate maintenance
payments need not be disclosed Source of other income: _______________________________ Gross Monthly Amount $______________ REFERENCES: Nearest relative not living with you: Name:_______________________ Relationship: ___________ Address: __________________________ City: ____________________ State: ______ ZIP: __________ Telephone #: (______)______-_________ Please indicate which of the below applies to you: [ ] Financed with Kubota Credit Corp. [ ] Had a repossession [ ] Been sued [ ] Filed Bankruptcy [ ] Been subject to a tax lien [ ] Had a foreclosure I HEREBY CERTIFY THAT THESE STATEMENTS ARE CORRECT TO THE BEST OF MY KNOWLEDGE AND ARE MADE FOR THE PURPOSE OF OBTAINING FINANCING FROM KUBOTA CREDIT CORPORATION, U.S.A. I AUTHORIZE YOU TO OBTAIN ANY INFORMATION INCLUDING BUT NOT LIMITED TO CREDIT REPORTS WHICH YOU MAY REQUIRE CONCERNING THIS APPLICATION AND I AGREE THAT THIS APPLICATION SHALL REMAIN YOUR PROPERTY, WHETHER THE FINANCING IS GRANTED OR NOT. I hereby authorize this CREDIT APPLICATION may
be forwarded to credit, finance and leasing organizations for their confidential
consideration. APPLICANT SIGNATURE:__________________________________________________ DATE:________________ Print a copy of the application, fill it out, and send it to us via mail (P.O. Box 1825, Lexington, NC 27293) or via fax (336-243-5820). |