Rotex Air Conditioning Credit Application

CREDIT APPLICATION: A/C CREDIT PROGRAM

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Applicant Information

Name

First

Last

Social Security Number

Address

Address Line 1

City

State

Zip Code

Phone

Years Lived at Home

Mortgage Information:

Financial Holder or Owner Lender name

Seller's Phone Number (If Applicable)

Mortgage Monthly Payment

Remaining Balance on the House ($)

Employment Information:

Retired?

Employer name

Position

Work Phone

Gross Monthly Income ($)

Other Gross Monthly Income ($)

How Long You Have been working there? (years)

Additional Comments about income (optional)

Work Address

Address Line 1

City

State

Zip Code

Upload Documentation:

Identification

Click or drag a file to this area to upload.

Driver's License / Passport / ID / Consular ID

AUTHORIZATION

AUTHORIZATION *

I certify the above information is complete and accurate. I authorize ROTEX A/C & HEATING to contact credit bureaus to check my credit, as well as to disclose this information to financial institutions in order to obtain financing (When applicable).

Signature

Clear Signature