MEKKELSEN RV Attn: CASEY, Business Manager PHONE: 802-233-3684
 P.O. Box 129  /  East. Montpelier, VT 05651             FAX:       802-229-6319

The Federal Credit Equal Opportunity Act requires that you retain the Application in your files

for 25 months after the date you give the applicant(s) notice of action taken on this Application.

 

Check appropriate box - We acknowledge that we are applying for Joint Credit:                       Applicant 1Yes           No                        Applicant 2 Yes          No
If "Yes," Applicant 1 should fill in spaces marked "1" and Applicant 2 line spaces marked "2."  If any information is the same for both applicants, Applicant 2 may write in "SAME"
Name       Birthdate   Phone Number   Social Security Number  
1.)       1.)   1.)     1.)      
                           
2.)       2.)   2.)     2.)      
Address   City   State   Zip How Long Previous Address (If less then 5 years)
1.)               1.) 1.)      
                           
2.)               2.) 2.)      
Employer (Name / Address) Bus. Phone   Position   How Long Gross Mo. Salary   Prev. Employer How Long
1.)   1.)   1.)   1.) 1.)   1.)     1.)
                           
2.)   2.)   2.)   2.) 2.)   2.)     2.)
OTHER INCOME: ALIMONY, CHILD SUPPORT OR SEPARATE MAINTENANCE Source (Name / Address)         Mo. Amount
INCOME NEED NOT BE REVEALED IF YOU DO NOT WISH TO HAVE IT   1.)               1.)
CONSIDERED AS A BASIS FOR REPAYING THIS OBLIGATION.                    
          2.)               2.)
PROPERTY INFORMATION:  IF PROPERTY IS OWNED AND TAXES ARE NOT INCLUDED IN THE MONTHLY PAYMENT, LIST ANNUAL TAXES PAID IN THE SPACES PROVIDED BELOW.      
  Mo. Payment Annual Taxes Mortgage Bal.   Mortgage Holder Checking Account At   Savings Account At
1.) Own  [  ]                          
     Rent  [  ]                          
2.) Own  [  ]                          
     Rent  [  ]                          
LIST ALL DEBTS TO BANKS, STORES, FINANCE COMPANIES, CREDIT UNIONS AND OTHERS.  INCLUDE ALL OBLIGATIONS TO PAY ALIMONY, CHILD SUPPORT OR
SEPARATE MAINTENANCE.                        
  Applicant 1's Creditors Mo. Payment Balance     Applicant 2's Creditors     Mo. Payment Balance
  Auto (Year / Make)            Auto (Year / Make)          
1.)                          
                           
2.)