Online Credit Application

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Are you applying jointly with another individual?

Do you know which unit you are interested in purchasing?

Do you have a unit that you will be trading in?

Do you currently have an insurance provider for the desired collateral type?

Personal Information

Please enter the personal information for the primary applicant. All bold * fields are required.

First Name*

Middle Name*

Last Name*

Suffix*

SSN*

Date of Birth*

Email*

Driver's License Number*

State*

Home Phone*

Cell Phone*

- Current Residence

Please enter the current residence information for . This must be the physical address where resides. If has a separate mailing address, you can select that option separately. All bold * fields are required.

Street #*

Street Address*

Apt #*

ZIP*

City*

County*

State*

How Long*
	years	months

Status*

Monthly Rent/Mortgage Pmt*

$

Landlord/Mortgage Co*

Landlord/Mortgage Phone*

Is your mailing address different than your current/physical address?

- Previous Residence

Most lenders require previous residence information if an applicant has not lived at their current residence for over 2 years. Since meets this criteria, please enter the previous residence information for . All bold * fields are required.

Address*

Address Line 2*

ZIP*

City*

County*

State*

How Long*
	years	months

- Current Employment

Please enter the current employment information for . All bold * fields are required.

Status*

Occupation*

Employer Name*

Gross Salary*
$

Work Phone*

How Long*
	years	months

Address*

ZIP*

City*

State*

Does have a secondary job/employment with a minimum of 1 year tenure?

Does have any other sources of income? (e.g. Alimony, Child Support, etc.)

Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

- Secondary Employment

Please enter the secondary employment information for . All bold * fields are required.

Occupation*

Employer Name*

Gross Salary*
$

Work Phone*

How Long*
	years	months

Address*

ZIP*

City*

State*

- Previous Employment

Most lenders require previous employment information if an applicant has not worked at their current job for over 2 years. Since meets this criteria, please enter the previous employment information for . All bold * fields are required.

Status*

Occupation*

Employer Name*

Gross Salary*
$

Work Phone*

How Long*
	years	months

Address*

ZIP*

City*

State*

- Other Income

Please enter any other sources of income for . All bold * fields are required.

Gross Income*
$

Source*

Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

Personal Information

Please enter the personal information for the secondary applicant. All bold * fields are required.

First Name*

Middle Name*

Last Name*

Suffix*

SSN*

Date of Birth*

Applicant Relation*

Email*

Driver's License Number*

State*

Home Phone*

Cell Phone*

- Current Residence

Please enter the current residence information for . This must be the physical address where resides. If has a separate mailing address, you can select that option separately. All bold * fields are required.

Same residence information as

Street #*

Street Address*

Apt #*

ZIP*

City*

County*

State*

How Long*
	years	months

Status*

Monthly Rent/Mortgage Pmt*

$

Landlord/Mortgage Co*

Landlord/Mortgage Phone*

Is your mailing address different than your current/physical address?

- Previous Residence

Most lenders require previous residence information if an applicant has not lived at their current residence for over 2 years. Since meets this criteria, please enter the previous residence information for . All bold * fields are required.

Address*

Address Line 2*

ZIP*

City*

County*

State*

How Long*
	years	months

- Current Employment

Please enter the current employment information for . All bold * fields are required.

Status*

Occupation*

Employer Name*

Gross Salary*
$

Work Phone*

How Long*
	years	months

Address*

ZIP*

City*

State*

Does have a secondary job/employment with a minimum of 1 year tenure?

Does have any other sources of income? (e.g. Alimony, Child Support, etc.)

Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

- Secondary Employment

Please enter the secondary employment information for . All bold * fields are required.

Occupation*

Employer Name*

Gross Salary*
$

Work Phone*

How Long*
	years	months

Address*

ZIP*

City*

State*

- Previous Employment

Most lenders require previous employment information if an applicant has not worked at their current job for over 2 years. Since meets this criteria, please enter the previous employment information for . All bold * fields are required.

Status*

Occupation*

Employer Name*

Gross Salary*
$

Work Phone*

How Long*
	years	months

Address*

ZIP*

City*

State*

- Other Income

Please enter any other sources of income for . All bold * fields are required.

Gross Income*
$

Source*

Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

Desired Unit

Please enter the information for the unit you are looking to purchase and finance below. All bold * fields are required.

Type of Unit*

Inventory Stock Number*

Type*

Year*

Make*

Model*

Class Type*

Length*

Body Style*

Horsepower*

Fuel Type*

Drive*

Mileage*

Color*

VIN/Serial Number*

Boat/Hull Info Add

Motor Info Add

Trailer Info Add

Please enter the information for the unit you are looking to trade in below. All bold* fields are required.

Year*

Make*

Model*

VIN/Serial Number*

Mileage*

Balance Owed*

$

Lienholder*

Please enter the information for the unit you are looking to trade in below. All bold* fields are required.

Year*

Make*

Model*

VIN/Serial Number*

Mileage*

Balance Owed*

$

Lienholder*

Insurance Information

Please enter the insurance information for the primary applicant. All bold* fields are required.

Insurance Carrier Company Name*

Policy #*

Agent Name*

Agent Phone Number*

Deductible*

$

Personal References (Optional)

Please enter personal reference inforamtion below.

Personal Reference #1

Name*

Relationship*

Phone*

Address*

ZIP*

City*

State*

Personal Reference #2

Name*

Relationship*

Phone*

Address*

ZIP*

City*

State*

Primary Applicant

Name:

Date of Birth:

SSN:

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Current Residence:

Edit

Mailing Address:

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Previous Residence:

Edit

Current Employment:

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Secondary Employment:

Edit

Previous Employment:

Edit

Other Income: ()

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Secondary Applicant

Name:

Date of Birth:

SSN:

Edit

Current Residence:

Edit

Mailing Address:

Edit

Previous Residence:

Edit

Current Employment:

Edit

Secondary Employment:

Edit

Previous Employment:

Edit

Other Income: ()

Edit

Collateral

Edit

Trade-In

Edit

Insurance Information

Insurance Carrier Company Name:

Edit

Policy #:

Agent Name:

Agent Phone Number:

Deductible:

Personal References

None

Edit

Name:

Relationship:

Phone:

Edit

Name:

Relationship:

Phone:

Edit

Payment Information (optional)

How much cash down payment are you willing to make?*

$

What is your preferred maximum monthly payment?*

$

Notice to Residents

Dealer Message

Consumer Report Authorization

By signing below, you authorize White River Financial Services, L.L.C., including its affiliates and subsidiaries (collectively, “WRFS”), and any finance company evaluating your credit application, to obtain consumer reports and related information about you from one or more consumer reporting agencies.

Pursuant to this authorization, you consent to WRFS and any finance company obtaining consumer reports about you during the processing and reviewing of your application, any final reviews prior to a credit decision and, if the application is approved, and at various times during the term of the credit agreement, including but not limited to:

· underwriting and verifying information in the application;

· authenticating my identity;

· servicing, collection, maintenance, update, or extension of the credit agreement; and

· mitigating fraud, unauthorized transactions, and other illegal activities.

You authorize WRFS and any finance company to contact third parties and to obtain such information that they may require in order to verify information relative to this application, including contacting spouses to verify spouse-related information. You further authorize the release from third parties of any records necessary to verify information about you and to answer questions about their credit experience with you including but not limited to late payments, missed payments or other defaults, and this information may be reported in your credit report.

In connection with the purposes above, you authorize WRFS to share all or parts of your consumer reports and any other information gathered pursuant to this authorization with finance companies, agents, service providers, counterparties, affiliates, or any successor-in-interest who may be involved in evaluating your application, extending credit to you, or servicing any credit agreement you may enter into.

You certify that all information given by you on this application is complete and accurate.

Legal Disclosure

You agree that your telephone communications with us and any financial company that reviews this credit application may be monitored and/or recorded to assure the quality of service. You give your consent to receive calls and text messages from the creditor or its third party debt collector at any number you have given us in this credit application or in the future; including calls and messages made using an auto dialer or prerecorded message, even if the telephone number is a cell phone number or other wireless device and the contact or message results in a charge to you. You agree that we can send disclosures or other communications to you electronically at the e-mail address you have given us.

IMPORTANT APPLICANT INFORMATION: Federal law requires financial companies to obtain sufficient information to verify your identity. You may be asked several questions and to provide one or more forms of identification to fulfill this requirement. In some instances we may use outside sources to confirm the information.

By entering your name below & submitting this application, you certify that the information provided on the application is, to the best of your knowledge, complete and accurate. You agree to provide your electronic signature, acknowledge receipt of any Disclosures and agree to the E-SIGN CONSENT. By submitting this credit application you understand that we and the financial institution(s) will rely on this information to judge your credit worthiness, and will retain this application and information about you whether or not this application is approved.

Further, you authorize an investigation of your credit and employment history, which will include obtaining credit report(s) from one or more consumer credit reporting agencies. You further understand that we and/or the financial institution(s) that evaluate your application may require additional information. You agree that you will accept disclosures or other communications electronically at the e-mail address you have given us. You agree that we or any financial institution(s) that review this credit application may call or text you at the phone number you have given us in this application.

You understand that false statements may subject you to criminal penalties.

Upon successful submission of this application, you will receive an email with a link to download a copy of the completed credit application for your records. If you do not wish to electronically sign & submit this application online, you may print the credit application (by clicking on the printer icon above) and manually sign and submit it off-line.

Enter Your Full Name*

Salesperson Name (optional)*

Notes to Dealer (optional)*

E-SIGN CONSENT

Purpose

How to contact us

Email address

Hardware and Software Requirements:

System Requirements