Wade's Heating, Cooling & Electrical Consumer Application | Dealer Direct

IMPORTANT APPLICANT INFORMATION: Federal law requires financial institutions to obtain sufficient information to verify your identity. You may be asked several questions and to provide one or more forms of identification to fulfill this requirement. In some instances we may use outside sources to confirm the information. The information you provide is protected by our privacy policy and federal law.

*indicates required fields

Joint Credit?

Yes

Applicant Information

* First Name

* Middle Name

* Last Name

* Email Address

* Present Address

Apt. #

* City

* State

* Zip

* Time at Address

* Time at address less than 2 years?

Yes

* Social Security #

* Date of Birth

* Phone #

* Mailing address different than above?

Yes

* Current Employer (If Self-Employed, Business Name)

* How Long?

* Employer Address

* City

* State

* Zip

* Business Phone #

* Position

Co-Applicant Information

* First Name

* Middle Name

* Last Name

* Email Address

* Present Address

Apt. #

* City

* State

* Zip

* Time at Address

* Time at address less than 2 years?

Yes

* Social Security #

* Date of Birth

* Phone #

* Mailing address different than above?

Yes

* Current Employer (If Self-Employed, Business Name)

* How Long?

* Employer Address

* City

* State

* Zip

* Business Phone #

* Position

* Are you or have you ever been a customer of First Community Bank?

Yes

* Landlord or Mortgage Holder

* Payment

Buy

Rent

Own

Parents

Other

* Name of Nearest Relative Not Living with You

* Nearest Relative's Phone #

* Nearest Relative's Address

* City

* State

* Zip

* Applicant Salary (Gross Monthly)

Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation. Alimony, child support, separate maintenance received under:

Court Order

Written Agreement

Oral Understanding

* Sources of Other Income

* Amount Per Month

Married

Separated

Unmarried **

** Includes single, divorced or widowed

Term Desired

36 month term

60 month term

Signing up for automatic draft payment at the time you close the loan will reduce your loan processing fee from $175 to $150.

Would you like to sign up for auto draft at this time?

Yes, I would like to sign up for auto draft.

No, I would not like to sign up for auto draft.

This Application for Credit (“Application”) is to First Community Bank (“FCB”). I have read this Application, and everything stated in it is true. I authorize FCB to check my credit, employment history, or any other information, and to report such information, and its credit experience with me, to others. I am at least 18 years of age.

I hereby certify that the property purchased pursuant to this application is for my personal and/or business use; that I am fully responsible for making all payments for such property; that such property will be in my possession or under my control until the amount financed and all finance charges have been paid in full; and that I am not purchasing any property financed through FCB for the benefit of another without the written approval of FCB. I understand that I must update credit information at FCB’s request if my financial condition changes.

* Signature

* Date Signed