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*Required Fields (Required fields show up in red text.) Click Here for a pdf version of this form.
Applicant Co-Applicant
*Full Name(First, Middle, Last)
 Full Name(First, Middle, Last)
*Street Address
 Street Address
*City   *State   *Zip   *Time at address
yrs. mos.
City   State   Zip   Time at address
yrs. mos.
*No. of dependents   *Home Phone
No. of dependents   Home Phone
Own
Rent
Other 		  *Mortgage/Landlord   *Current
 Value 		  *Monthly Payment
$
Own
Rent
Other 		  Mortgage/Landlord   Current
Value 		  Monthly Payment
$
For Security Reasons, Nelson Marine will contact you for the following information after your application has been submitted.
Date of Birth Social Security Number
Date of Birth Social Security Number
*Previous Street Address (if current is less than 3 years)
 Previous Street Address (if current is less than 3 years)
*City   *State   *Zip   *Time at address
yrs. mos.
City   State   Zip   Time at address
yrs. mos.
*Employer   *Position   *Business
 Phone 		  *Monthly
 gross
 income
$
Employer   Position   Business
 Phone 		  Monthly
 gross
 income
$
*City   *State   *Zip   *How long with employer
yrs. mos.
City   State   Zip   How long with employer
yrs. mos.
Previous employer (if current is less than 3 years)   Position
Previous employer (if current is less than 3 years)   Position
City   State   Zip   How long with employer
yrs. mos.
City   State   Zip   How long with employer
yrs. mos.
Additional Income
I do not have to reveal alimony, child support, or maintenance income unless I wish to be considered as a basis for repayment.   Nature of additional income   Monthly amount   How long will it last?
yrs. mos.
References
Bank Reference (Name and City)   Checking     Savings   Member of A.C.U.
Yes     No
Credit Union (Name and Phone)
 Nearest relative not living with you (Name, Address, and Phone)
Credit Obligations (include those of co-applicant if different)
Type Creditor Payment Balance Type Creditor Payment Balance
Auto Credit
Account
Credit
Account 		Other
*Have you ever filed bankruptcy? Yes No   How long ago?
I certify that the information stated in this application is true, correct to the best of my knowledge and a complete statement of any financial condition. I understand that this application will be kept whether or not it is approved. You and any subsequent creditors are authorized to check my credit and employment history to answer questions about your experience with me and disclose credit information to each other.
Applicants Agreement
Yes, I agree to the terms stated above.
No, I do not agree to the terms stated above. 		  Co-Applicants Signature
Yes, I agree to the terms stated above.
No, I do not agree to the terms stated above.
Description
Dealer Name / Number
Contact
Sale Price including tax, lic., accessories
Less Downpayment
Amount Financed Term Req.
What Package are you looking to be approved for?
Item Year Type
Boat
Motor
Trailer
Other
Applicant Signature

                                                                                                                                     		Co-Applicant Signature

                                                                                                                                   
 
 
 
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