Credit Reference Form

Hermanson’s Auto Warehouse

13 Eastern Ave- Eastern Spaces Warehouses

Center Conway, NH 03813

Applicant Name(s)__________________________ _____ D.O.B.____________

SS# Licence #

Home Phone___________________ Cell Phone _____________________ Alt Phone#

Mailing Address_________________________________________________

Physical Address (rent/own)___________________________________________

Landlords Name Address Phone

Monthly Rent/ Mortgage ________Previous Address _________ __________________

Employer Name Address Phone

Position Held_____________________ Supervisor Name_______________________

Work Number____________________

Work Schedule- M T W Th F Sa Su

Ave Wk Hours Ave Weekly Pay Proof/pay stubs

References: All below references need to be filled out for credit approval

Closest blood Relative- Address- Number

Spouse/Roomate- Address- Number

Mother- Address- Number

Father- Address- Number

Other Ref.- Address- Number

Have you ever defaulted on a loan before? Yes No

If yes, why?

I certify that all information contained on this application is true and complete to the best of my knowledge. I authorize the contact of any reference and use of any information provided concerning my credit account here at Hermanson’s Auto Warehouse LTD. The data you provide is subject to the provisions of the Privacy Act (5 U.S.C. 552a). I understand that this information will be used to collect the money that is owed on you account. I will report any changes in Name, Residency, Phone Numbers, Employment, and/or other pertinent information with-in 30 days to Hermanson’s Auto Warehouse LTD.

Applicant Signature___________ ____________________ Date_________________

Customers obligations/requirements for credit approval

Hermanson’s Auto Warehouse LTD as a lender requires our customers to fulfill the following obligations to qualify for credit:

I agree to keep full coverage insurance on this vehicle until it is paid in full. I understand that I am in default on my loan with Hermanson’s Auto Warehouse Ltd if I loose coverage. By being in default we Hermanson’s Auto Warehouse LTD have the right to reclaim the vehicle and keep in in our possession until insurance is recovered.

Customers initial

I understand that credit is granted to me on the basis that I have payments automatically withdrawn from my account. By signing this I understand additionally that I will be in default on my loan if the payment is declined, or the account attached to this automatic payment is closed. A cash payment must be brought in to Hermanson’s Auto Warehouse LTD immediately to replace the declined automatic payment. In the case that the account linked to the automatic payment has been closed, a new account must be linked in place of the old one. Failure to do this puts you in default on your loan. Once you are in default on your loan, Hermanson’s Auto Warehouse LTD then has the right to repossess the vehicle.

Customers initial

Once the vehicle is repossessed for non payment your credit is no good. You will be given 15 days to pay your balance in full to reclaim the vehicle. If you choose not to pay the balance in full with-in 15days Hermanson’s Auto Warehouse LTD has the right to resell the vehicle. Before reselling the vehicle we may need to repair it. These costs will be added to the debt owed. In addition there may be fees and other cost such as towing and repossession fee. Any proceeds will be applied to the balance owed on your account. Any surplus will be paid to you, if there is a debt you will owe us.

Customer signature: Date:

Customer Printed Name: