Customer Credit Application

	Skip the first field if not working with one of our staff. Working With Matthew KortmanEvan ShepardRyan MaddenBob WellsRick StetsonDale LogueJeremy SchererPete Vander KolkJamie McquillanGabrielle SelviusMike FleserRandy Bursley Fax 616-301-6924 Phone 616-301-6920 Applicant Prefix Mr.Ms.Dr. First Name* Last Name* Birth Date (mm/dd/yyyy) Address 1* City* Drivers Lic. # State/Province UNITED STATES AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTenneseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming CANADA AlbertaBritish ColumbiaManitobaNew BrunswickNew FoundlandNorhtwest TerritoriesNova ScotiaOntarioPrince Edward IslandQuebecSaskatchewanYukon AUSTRALIA Australian Capital TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia Postal Code Social Sec. # * Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua And BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamas, TheBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, Democractic Republic of the Cook IslandsCosta RicaCote D'Ivoire (Ivory Coast)Croatia (Hrvatska)CubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Islas Malvinas)Faroe IslandsFiji IslandsFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambia, TheGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHondurasHong Kong S.A.R.HungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKoreaKorea, North KuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacau S.A.R.Macedonia, Former Yugoslav Republic ofMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlands AntillesNetherlands, TheNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua new GuineaParaguayPeruPhilippinesPitcairn IslandPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint HelenaSaint Kitts And NevisSaint LuciaSaint Pierre and MiquelonSaint Vincent And The GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia And The South Sandwich IslandsSpainSri LankaSudanSurinameSvalbard And Jan Mayen IslandsSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTokelauTongaTrinidad And TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican City State (Holy See)VenezuelaVietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis And Futuna IslandsYemenYugoslaviaZambiaZimbabwe Home Phone E-Mail* Employment and Other Income Employers Name Time On Job 0123456789101112131415161718192021222324252627282930 years Salary $ (Annual) Work Phone Source Of Other Income Amount $ (Monthly) Mortgage and Bank Info Mortgage Holder Mortgage Payment $ (Monthly) Personal Bank Account Type: Checking´s Savings Both Joint Applicant Prefix Mr.Ms.Dr. First Name Last Name Date Of Birth (mm/dd/yyyy) Address City Drivers Lic. # State/Province UNITED STATES AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTenneseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming CANADA AlbertaBritish ColumbiaManitobaNew BrunswickNew FoundlandNorhtwest TerritoriesNova ScotiaOntarioPrince Edward IslandQuebecSaskatchewanYukon AUSTRALIA Australian Capital TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia Postal Code Social Sec. #* Home Phone Joint Applicant Employer Employer Name Time On Job (YR.) 0123456789101112131415161718192021222324252627282930 Salary $ (Annual) Work Phone Source Of Other Income Amount $ (Monthly) TELL US WHAT YOU WANT TO FINANCE (Any specifics are appreciated.) Down Payment $ ie. 1000 I/We CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND COMPLETE TO THE BEST OF MY/OUR/ KNOWLEDGE