Can Do Powersports - Hazleton, PA - Online Credit Application

Welcome to our Secure Online Credit Application. Please fill in all required fields and click 'Submit' to send your application to Maureen in our Finance Department. Don't forget, you can always stop in to fill out a paper credit application as well. ** If you want to exit without submitting your application, please click the 'Cancel This Application' button at the bottom to return to our home page.
* - Required Fields

I am looking to purchase a:	*

First Name	*
Initial
Last Name	*
Current Address	*

City	*
State	*
Zip	*

Home Phone	*	(ie. 800-234-1234)
Work Phone	*	(ie. 800-234-1234)
Email Address

Date Of Birth	*	(ie. mm-dd-yyyy)
Social Security No.	*	(ie. xxx-xx-xxxx)

Drivers License #	*
State of Issuance	*

Housing Status	*	Own Rent Live With Parents Other
Monthly Rent/Mortgage:	*	(ie. 400)
How long at current address?	*	yrs mos (no blanks, please use '0')
If less than 2 years at current address, please provide most recent address:
Address

City
State
Zip
How long at this address?		yrs mos (no blanks, please use '0')

Gross Annual Income:	*	(ie. 50,000)
Additional Income:		(ie. 1,000) Source:
Checking Account?	*	Yes No Bank Name:
Savings Account?	*	Yes No Bank Name:
Current Employer:	*	If unemployed, type 'NA' If self-employed, type 'Self'
Business Address:

City:		State: Zip:
Position:
Hire Date:	*	(ie. mm-yyyy or date of unemployment)
If less than 2 years at current employer, please provide your previous employer:
Previous Employer Name:
Phone Number:		(ie. 800-234-1234)
Name of Immediate Supervisor:

Nearest Relative Not Living With You:	*
Address:

City:		State: Zip:
Phone Number:		(ie. 800-234-1234)
Relationship to you:

Have you ever declared bankruptcy?	*	Yes No
Are there any unsatisfied judgements against you?	*	Yes No
Any Money Down?

Additional Comments or Instructions:
NOTICE: By clicking 'Submit', I hereby certify that all information provided in the application is complete and accurate to the best of my knowledge. My typed signature and date below authorizes Can-Do Powersports to perform a credit check. * Signature * Date (ie. xx-xx-xxxx)