Application for Credit

This is an application for credit with Stay Dry Ohio, LLC. You understand there is no agreement between us until we approve your credit application and accept all other required documents for funding.

Please Print Clearly and Complete All Requested Information.

INDIVIDUAL APPLICATION

JOINT APPLICATION

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Applicant Information

First Name

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Last Name

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DOB

Please enter your date of birth

SSN

Please enter your SSN

Drivers' Lic. #/State

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Home Address/City/State/Zip

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Home Phone

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Cell Phone

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OWN

RENT

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How Long at Current Address?

Years

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Mos.

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Mortgage or Rent Pmt.

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Email Address

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Current Employer

Please enter your current employer name

How Long?

Please enter a number

Position

Please enter your current position

Employer Phone

Please enter employer's phone number

Gross Mo. Income

Please enter your gross month income

Co-Applicant Information

First Name

Please enter co-applicant first name

Last Name

Please enter co-applicant last name

DOB

Please enter co-applicant date of birth

SSN

Please enter co-applicant SSN

Drivers' Lic. #/State

Please enter co-applicant driver license #/State

Home Address/City/State/Zip

Please enter co-applicant address/city/state/zip

Home Phone

Please enter a phone number

Cell Phone

Please enter a phone number

OWN

RENT

Please select at least one check box

How Long at Current Address?

Years

Please enter a number

Mos.

Please enter a number

Mortgage or Rent Pmt.

Please enter a number

Email Address

Please enter an email address

Current Employer

Please enter co-applicant current employer name

How Long?

Please enter a number

Position

Please enter co-applicant current position

Employer Phone

Please enter co-applicant employer's phone number

Gross Mo. Income

Please enter co-applicant gross month income

Other Income (Alimony, child support or separate maintenance income need not be revealed if you do not wish to have in considered as a basis for repaying this obligation)

Source

Please enter other income source

Amount

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Personal References (not in same household)

Name Please enter a name

Phone Please enter a phone number

Relationship Please enter relationship

Name Please enter a name

Phone Please enter a phone number

Relationship Please enter relationship

Optional Ach (Automatic Withdrawals)

I(we) hereby authorize lender or any assignee to initiate debit entries to the below-listed account for my monthly payments. This authorization remains in full force and effect until the lender/assignee has received written notification from me(us) in such time and such manner as to afford lender/assignee a reasonable opportunity to act on it. Please allow 10 days for all changes to be effective.

Bank Name Please enter a bank name

City/State Please enter a city/state

CheckingSavingsInvalid Input

Routing # Please enter a number

Acct # Please enter a number

**Please Attach a Voided Check or Deposit Slip**

By signing this application you promise all information is true and complete. You intend the seller and/or assignee to rely upon this information in deciding whether or not to extend credit to you. You authorize a full investigation and release of your credit record and your employment history. You also authorize the seller and/or assignee to release information about credit experience with them. You consent to receiving autodialed or prerecorded message calls from us or those acting on our behalf at any mobile telephone number you provide to us.
CREDIT REPORT NOTICE: We may request a credit report for any legitimate purpose associated with your application for credit, extending credit, modifying the terms of your credit agreement, or collection on your account. On your request, we will inform you if such a report was ordered and will give you the name and address of the credit reporting agency that furnished the report.
ALABAMA AND NEBRASKA RESIDENTS: You must be 19 years old to apply for credit.
CALIFORNIA RESIDENTS: If married, you may apply for a separate account.
NEW YORK RESIDENTS: We may obtain your credit report and we will inform you, upon request, whether a report was obtained and, if so, the name and address of the consumer reporting agency.
OHIO RESIDENTS: The Ohio laws against discrimination require that all creditors make credit equally available to all credit worthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio civil rights commission administers compliance with this law.
VERMONT RESIDENTS: We may obtain your credit reports at any time, for any legitimate purpose associated with the account or the application or request for an account, including but not limited to reviewing, modifying, renewing and collecting on your account. On your request we will inform you if such a report was ordered. If so, we will give you the name and address of the consumer reporting agency furnishing the report.
WISCONSIN NOTICE TO MARRIED APPLICANTS: No provision of any marital property agreement, unilateral statement under Wis. Stats. §766.59, or court decisions under Wis. Stats. §766.70 adversely affects the interest of the creditor unless the creditor is furnished a copy of the decree, agreement, statement, or has actual knowledge of the adverse provision prior to the time credit is granted.

Applicant Signature

Please enter your first and last names

Date

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Co-Applicant Signature

Please enter co-applicant first and last names

Date

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Application for Credit

Applicant Information

Co-Applicant Information

Personal References (not in same household)

Optional Ach (Automatic Withdrawals)

Stay Dry Waterproofing, LLC

Columbus Office

Marysville Office

Lancaster Office

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