Online Credit Application

YOUR PERSONAL INFORMATION

Your Full Name *

Social Security Number *

Driver's License Number *

Date of Birth *

Street Address *

Street Address

City *

State *

Zipcode *

Do you have a phone or utility bill in your name? *
 Yes No
Do you have a checking account in your name? *

Do you have a savings account in your name? *

Do you Rent or Own? *
 Rent Own
Monthly Rent or Mortgage Amount *

Residency Length *

Home Telephone *

Email Address *

Previous Address (if less than 2 years at your current address)

Street Address

Street Address

City

State

Zipcode

Name of nearest relative not living with you

Name *

Street Address *

Street Address

City *

State *

Zipcode *

Telephone *

EMPLOYMENT INFORMATION

Are you self employed? *
 Yes No
Current Employer *

Job Title *

Work Telephone *

Employment Length *

Monthly Income (Before Taxes) *

PREVIOUS EMPLOYMENT INFORMATION (if current job is less than 2 years)

Self employed?
 Yes No
Previous Employer

Job Title

Work Telephone

Employment Length

ADDITIONAL INCOME INFORMATION (Optional)
Alimony, child support, spousal income and separate maintenance income need not be disclosed if you do not wish to have it considered as a basis for repaying this obligation.

Amount (Annual)

Source

OTHER INFORMATION

What type of scooter are you looking for?

What size of scooter are you looking for?

Trade-In or Vehicle Interested In

TERMS AND CONDITIONS

In submitting this credit application, I certify that the information provided on this application is, to the best of my knowledge, complete and accurate. I understand that Vespa Milwaukie and financial institution(s) will rely on this information to judge my credit worthiness, and will retain this application and information about me whether or not this application is approved. Further, I authorize an investigation of my credit and employment history, in conjunction with which my credit report may be obtained from one or more consumer credit reporting agencies. I understand that false statements may subject me to criminal penalties. I further understand that Vespa Milwaukie and/or the financial institution(s) that evaluate my application may require additional information.

I agree to the terms and conditions of this application listed above and give permission to Vespa Milwaukie 4150 SE Roethe Rd. Milwaukie Or. 97267 to run an automotive credit check on my behalf.

DIGITAL SIGNATURE