High Tech Mobility CREDIT APPLICATION Print a copy


	Print a copy of this application; fill it out completely ( please print legibly) and mail or FAX it back to:

	HIGH TECH MOBILITY SYSTEMS 141 Church Ave, Hueytown, AL 35023 (205) 491-2109, (205) 491-7772 (FAX)

	PRIMARY APPLICANT


	LAST NAME FIRST NAME MIDDLE INITIAL

DATE OF BIRTH


SOCIAL SECURITY

PRESENT ADDRESS

HOW LONG? (yrs)

PREVIOUS ADDRESS (If present address less than 2 yrs.)

HOW LONG? (yrs)

HOME PHONE NUMBER

OWN HOME?

PAYMENT

LANDLORD/MORTGAGE HOLDER

PURCHASE PRICE

MORTGAGE BALANCE

APPROX. VALUE OF HOME

OCCUPATION

WORK PHONE NUMBER

YEARLY GROSS WAGE OR SALARY

EMPLOYER ADDRESS

HOW LONG? (yrs)

NEAREST RELATIVE (not living at my address)

RELATIONSHIP

PHONE NUMBER

RELATIVE'S PRESENT ADDRESS

HOW LONG? (yrs)

OTHER YEARLY INCOME

SOURCE

BANK WITH SAVINGS / CHECKING ACCOUNT

CO-APPLICANT

LAST NAME FIRST NAME MIDDLE INITIAL

DATE OF BIRTH

SOCIAL SECURITY

PRESENT ADDRESS

HOW LONG? (yrs)

PREVIOUS ADDRESS (If present address less than 2 yrs.)

HOW LONG? (yrs)

HOME PHONE NUMBER

OWN HOME?

PAYMENT

LANDLORD/MORTGAGE HOLDER

PURCHASE PRICE

MORTGAGE BALANCE

APPROX. VALUE OF HOME

OCCUPATION

WORK PHONE NUMBER

YEARLY GROSS WAGE OR SALARY

EMPLOYER ADDRESS

HOW LONG? (yrs)

NEAREST RELATIVE (not living at my address)

RELATIONSHIP

PHONE NUMBER

RELATIVE'S PRESENT ADDRESS

HOW LONG? (yrs)

OTHER YEARLY INCOME

SOURCE

BANK WITH SAVINGS / CHECKING ACCOUNT



	I/WE CERTIFY THAT EACH OF THE STATEMENTS MADE AND ANSWERS GIVEN IN THIS CREDIT APPLICATION IS TRUE AND CORRECT. I/WE AUTHORIZE THE OBTAINING OF A CONSUMER REPORT.

PRIMARY APPLICANT'S SIGNATURE

DATE

CO-APPLICANT'S SIGNATURE



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