Night Vision Equipment Financing Application

* Required Field

Applicant

Date: *
Seller Name: *
Seller Address *
Description of Equipment: (Make, Model, and Description) *
Purchase Price: *
Loan Amount: $ *	Term: * months
Name: *
Home Phone: *	Home Phone Area Code - Home Phone Prefix - Home Phone Suffix
Cell Phone:	Cell Phone Area Code - Cell Phone Prefix - Cell Phone Suffix
Email: *
Social Security Number: *	Social Security Number 1 - Social Security Number 2 - Social Security Number 3
Birth Date *	Birth Date Month Birth Date Day Birth Date Year
Street Address: *
City: *
State: *
Zip: *
Physical Address (if different than mailing address)
Monthly Housing Cost (Rent or Mortgage): *
Present Employer: *	Phone:
Position: *	Years there: *
Gross Monthly Income:$*
Other Income:$	Source(s):

Examples of approximate monthly payments at 14.95% interest. This reference is provided for example only, actual loan amount will vary in accordance with amount of purchase.

Amount	Payments on 24 Month Loan	Payments on 36 Month Loan
$2,000	$97	$70
$3,000	$146	$105
$4,000	$194	$139
$5,000	$243	$174
$6,000	$291	$209
$7,000	$340	$243
$8,000	$388	$278
$9,000	$437	$313
$10,000	$485	$347
$11,000	$534	$381
$12,000	$582	$417
$13,000	$631	$451
$14,000	$679	$486
$15,000	$728	$521
$16,000	$776	$555
$17,000	$825	$590
$18,000	$873	$625
$19,000	$922	$659
$20,000	$970	$694

Everything that I have stated on this credit application is correct to the best of my knowledge. I understand that you will retain this application whether or not it is approved. You are authorized to check my credit and employement history and to answer questions about your credit experience with me/us. I fully understand that it is a federal crime punishable by fine or imprisonment, or both, to knowingly make any false statements concerning any of the facts as applicable under the provisions of Title 18, United States Code, Section 101.

I understand that attaching my e-signature is the legal equivalent of submitting a document signed by hand, and that clicking on the Submit button manifests my desire and intent to open a loan through Bank of 1889 to purchase night vision equipment.

Type the numbers you see above: