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 1-219-897-3297, or mail it to the following address: VanGorder Sales, 2897 N. State Road 3, Avilla, Indiana 46710. If you cannot print this form, please contact us and we will fax or mail you a form.

Please note: Click the SUBMIT THIS FORM button at the bottom of the page to send us your information over the internet for a quick approval decision. Before your equipment purchase is completed we will need an original signed copy of this form.

GENERAL APPLICANT INFORMATION Are you a U.S. Citizen? Yes No
First Name Middle Name Last Name
E-mail Address
Fed. Tax I.D. or Social Security Number Date of Birth //
Business Name
Current Street Address
City State Zip Code
County
Home Telephone Business Telephone
Number of Years at Address Type of Residence: Own Rent Lease Board Other
Please complete the Mailing Address if it is different than the Street Address.
Mailing Address
City State Zip
Please complete the Previous Address if you have been at your current address less than 3 years.
Previous Address
City State Zip
CURRENT EMPLOYER INFORMATION
Employer Name
Employer Address
City State Zip
Work Telephone Position
Number Years on Job Gross Monthly Salary
PREVIOUS EMPLOYER INFORMATION (if at Current Employer less than 2 years)
Employer Name
Employer Address
City State Zip
Work Telephone Position
Number of Years on Job Gross Monthly Salary
BUSINESS OR AGRICULTURAL INFORMATION
If you are self employed, what is your type of business?
Business Structure: Propietorship Corporation General Partnership (Application must be signed by a General Partner) Limited Partnership Limited Liability Company
Business Activity: Farming Plumbing/Sewer Excavating Sand/Gravel Rental
Equipment purchased for Agricultural Use Landscape/Mowing Construction Golf Course Other
Is the equipment purchased for custom use? Yes No
Number of years in business Part Time Full Time
Total number of acres farmed
Major Crops
Major Livestock
CO-APPLICANT INFORMATION
(Individual Co-Applicant required on Partnership, Corporation & LLC loans) 		Are you a U.S. Citizen? Yes No
First Name Middle Name Last Name
Fed. Tax I.D. or Social Security Number Date of Birth //
Business Name
Current Street Address
City State Zip Code
County
Home Telephone Business Telephone
FINANCIAL INFORMATION
Total Assets: Total Liabilities
Gross Annual Farm and Business Income
OTHER INCOME (Alimony, Child Support, or Separate Maintenance Payments need not be disclosed unless relied upon for creditworthiness) Source of other income Gross Monthly Amount
Have you ever filed bankruptcy? Yes No
Do you have any current judgements against you? Yes No
Do you have Farmers Home Administration Loans? Yes No
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 decrimination 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 VanGorder Sales, Inc. and our financial institution(s) (hereafter referred to as "VanGorder Sales") that 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 VanGorder Sales to verify all information in this statement and to provide any information requested by my (our) other creditors. I also grant VanGorder Sales 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 VanGorder Sales. I (we) also authorize VanGorder Sales to share all the foregoing information with its affiliates. I (we) release and waive all claims against VanGorder Sales 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.

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