Office use only                                                                                                                     Credit evaluation  ______
Credit approved (  )       Credit Denied  (  )                                                                               Credit limit         ______
Today’s date __/____/____                                                             Home  phone ______________
Full name_____________________________
Social security # _______________________                  Age _______         Date of birth _________
Address _____________________________
                _____________________________                  Zip ________  How long (yrs) __________
Own home _____       Buying home______          Renting______             Monthly payment ________
Landlord, mortgage, or contract holder _______________________
Previous address __________________________        Zip ________  How long (yrs) __________
Employer ________________________________                   Years employed ___________
Monthly income (take home) ___________
Credit references
1. Creditor ________________________________     Balance________Monthly payment ______
2. Creditor ________________________________     Balance________Monthly payment ______
Name of nearest relative _________________________________     
Address _____________________________________________
Phone number _____________________________
Co buyers name ____________________________      Social security # ______________
Address __________________________________      Monthly income ______________
Employer _________________________________
Address __________________________________

I/we authorize J.J. POWELL, INC. to make whatever credit inquires it deems necessary in connection with this credit application or in the course of review or collection of any credit extention in reliance on the application.  I/we authorize and instruct any person of consumer reporting agency to compile and furnish to the bank any information it may have or obtain in response to such credit inquires and agree that same shall remain your property whether or not credit is extended.  All information set forth in the application is declared to be true representation of fact made for the purpose of obtaining the credit requested and any willful misrepresentation on the application could result in criminal action.

I/we agree to pay the balance of any credit extended in full within 45 days of purchase or a finance charge will be applied to my/our account in the amount of 1.5%(18% APR).  Customer also agrees to pay all costs of collections including, but not limited to legal and attorney fee’s.

Applicants signature      _____________________________
Co applicants signature _____________________________