Ponderosa Trailers - Horse and stock trailers

CONSUMER APPLICATION

Please read the following before completing this form: (1) Applicant represents that the information given in this Application is complete and accurate and authorizes us to check with credit agencies, credit references and other sources disclosed herein investigating the information given. (2) Please read the entire agreement and sign below before submitting your Application.

(A) Tell Us About Yourself

* Indicates a required field

*First Name:

*Last Name:

*Email Address: Note: If your email address is entered incorrectly your application may not be received by us.

*Address:

*City:

*State:

*Zip:

*Social Security Number:

Home Phone:

Do You...

Own
Rent
Other

Amount Financed of Trailer

Monthly Payment

Total Value of Home

Birth Date

Number of Dependants

Time at Present Address

Your Employer

How Long? (years)

Total Annual Income

Employment Title

*Business Phone:

Note: Alimony, child support or separate maintenance payments need not be disclosed unless you wish to have it considered as a basis for repaying this obligation.

Nearest Relative Not Living With You:
First Name:
Last Name:
Email Address:
Address:
City:	State:	Zip:
Home Phone:

Wisconsin Applicants:If you are a married Wisconsin applicant, you must provide your spouse's information in the Joint Applicant section, even though your spouse may not be signing the application.

Joint Applicant
First Name:
Last Name:
Address:
City:		State:	Zip:
Social Security Number:
Home Phone:
Relationship to Applicant	Spouse Other
Birth Date
Your Employer
How Long? (years)
Total Annual Income
Business Phone:

(B) Applicant/Joint Applicant Signatures YES! I want to apply for Funancing Revolving Credit

Applicant(s): Please read the following: Applicant(s) ("you" or "your") requests a credit card(s) or revolving credit account. You represent that the information supplied in this credit application ("Application") is complete and accurate and that your Account will only be used for personal, family, or household purposes. You authorize Ponderosa Trailers and/or its financing institution ("we," "us," or "our") to obtain a consumer report from consumer reporting agencies in considering the application, and for the purpose of an update, renewal, extension of credit, review, or collection of your Account. Upon your request, we will inform you of the name and address of each consumer reporting agency from which we obtained a consumer report relating to you. You agree that there is no agreement between you and us until we approve your application. You agree that the Agreement provides for the compounding of finance charges. NOTICE TO THE APPLICANT(S)/BUYERS(S): (1)DO NOT SIGN THIS CREDIT APPLICATION/CREDIT AGREEMENT BEFORE YOU READ IT OR IF THE CREDIT AGREEMENT CONTAINS ANY BLANK SPACES. (2) YOU ARE ENTITLED TO A COMPLETELY FILLED IN COPY OF THE CREDIT AGREEMENT. You have read and agreed to be bound by the terms of this Application (including the accompanying Federal and State Notices) and the terms of the Agreement, which are incorporated into and made a apart of this Application. You acknowledge that you have kept the copy of the attached Agreement Form #36-14-130 (6/01) and you agree to be bound by its terms and conditions, which are hereby incorporated by reference and made a part of this application. You agree to be bound by any additional terms we mail you with the credit card.

Applicant Signature (type your name)

Date

Applicant's Driver's License

Joint Applicant Signature (type your name)

Joint Date

Joint Applicant's Driver's License

Optional Insurance Protection - Please Complete This Section To Enroll
I want Optional Safeline Insurance providing Credit Life, Disability, and Involuntary Unemployment Insurance.	Yes No
Type Your Initials Here
Enroll me in the Safeline credit insurance plan. I understand that insurance is not required to obtain credit and my decision to purchase insurance will not affect the credit terms in any way. I have read about its costs in the enclosed disclosure and authorize the premiums to be billed to my account.

Choose From The Following Options

Contact Us	View Our Catalog	Standard Features Steel
Why a Ponderosa Trailer?	Dealer Information	Warranty

Inquire About Our Trailers	Credit Application

Website Links

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Check out our other site www.ponderosatrailerparts.com

New Mexico Factory Store

Florida Factory Store

Company Information
Arkansas - 501-354-4717 ï 501-354-4314 FAX
New Mexico - 505-285-3614 • 505-285-3609 FAX