APPLIANCE TRADERS LIMITED LOAN APPLICATION ITEM PURCHASED:
MONTHLY INSTALLMENT:
TERM:
PERSONAL INFORMATION Title:
Mr.
Ms. Mrs. Dr. Prof.
Surname Name:
□ Male
Gender: First Name:
Date of Birth (dd/mm/yyyy):
□ Female
Middle Name:
Maiden/Alias Name:
Age:
Nationality:
Parish:
Country:
Current Address: Postal Code: Directions: Residential Status (Circle applicable response): [Owner (paying mortgage) ] [ Owner (fully paid for)] [ Family Residence] [ Renting ] [ Living with Parents] [ Leasing/Sharing] [ Other] Number of Years at Address:
Landlord Name:
Landlord Phone#:
Parish:
Country:
Parish:
Country:
Delivery address (If Different) : Postal Code: Previous Home Address: Postal Code: Number of Years at Previous Address: Marital Status (Circle applicable response):
Proof of Address: [Current Utility Bill ] [ Mortgage/Rent Receipt ] [ Single ]
[ Married ]
[ Divorced ]
[ Separated ]
[ Common Law ]
[Other ]
[ Widow]
Number of Dependents: CONTACT INFORMATION Email Address: Phone#:
Home#:
(Circle applicable response)
[Driver’s License ]
Work#: [ Passport ] [ Voter’s/National ID]
Exp Date:
ID# :
(dd/mm/yyyy):
TRN #: Employment Status (Circle applicable response):
[ Employed ]
[ Self Employed ]
Current Occupation:
[ Unemployed ]
[ Student ]
[ Retired ]
Employer:
Supervisor Name:
Employed Since:
Employer Address:
(dd/mm/yyyy) :
Previous Occupation:
Employer:
Supervisor Name:
Time at Previous Employment:
Employer Address: INCOME DETAILS
Bank Name: Bank Loan: [Yes ] Net Monthly Income:$
Account Type (Circle applicable response) : [ No]
Proof of Income: [ 2 Pay slips ]
[Job Letter]
Total Expenses:$
Additional Income:$
[Checking ]
[ 2 Months Bank Statement ]
[ Savings ]
Disposable Income:$
Source of Additional Income
EXPENSES Electricity: $
Water: $
Telephone:$
Cable: $
Rent/Mortgage: $
Other: $
Credit Card: $
Food: $
Loans: $ 1
[Other]
[ Record/Receipt Book ]
REFERENCE: SPOUSE Title:
Mr.
Ms. Mrs. Dr. Prof.
Surname Name:
First Name:
Middle Name:
Maiden/Alias Name:
Current Address: Postal Code:
City:
Country:
Phone#:
Home#:
Work#:
Known Since: (dd/mm/yyyy): Employment Status (Circle applicable response):
[ Employed ]
Occupation:
[ Self Employed ]
[ Unemployed ]
[ Student ]
[ Retired ]
Employer:
Employer Address: REFERENCE: RELATIVE NOT LIVING WITH YOU Title:
Mr.
Ms. Mrs. Dr. Prof.
Surname Name:
First Name:
Middle Name:
Maiden/Alias Name:
Current Address: Postal Code:
City:
Country:
Home#:
Work#:
Directions: Phone#: Occupation:
Employer:
Employer Address: Relationship to Customer:
Years Known to Customer: REFERENCE: FRIEND NOT LIVING WITH YOU
Title:
Mr.
Ms. Mrs. Dr. Prof.
Surname Name:
First Name:
Middle Name:
Maiden/Alias Name:
Current Address: Postal Code:
City:
Country:
Directions: Phone#:
Home#:
Occupation:
Work#: Employer:
Employer Address: Relationship to Customer:
Years Known to Customer: TERMS AND CONDITIONS
I/We certify that all statements made in this application are true and complete and are submitted for the purposes of obtaini ng credit. I/We authorize Appliance Traders Limited to obtain such information or verification as required concerning the statement s made in this application and from any credit reporting agency. I/We agree that the application shall remain Appliance Traders Limited’s pr operty whether it is approved or not. Customer Signature
Joint Applicant Signature
Date: __/__/20
Sales Representative Name
Date: __/__/20
Date: __/__/20
FOR OFFICE USE ONLY Completed & signed by main &/joints
□ Address Confirmation □
ID & TRN of Signatories
□
2 References for main/joint applicant holder Delivery Address Instructions Proof of Income
□
□
CREDIT OFFICER’S NAME:
SIGNATURE:
CREDIT MANAGER’S NAME:
SIGNATURE: 2
□
Stamped Copy Hire Purchase Agreement attained
□
Deposit/First Installment Paid
□