Bill Gardiner RV SuperCenter 800-905-7234
Fax: 765-447-8822

1. Applicant Information
Name:
Address:
Address2:
City,ST ZIPCO:
Housing Status :	Own / Buying Rent / Lease Live With Relative
Monthly Rent:
Email Address:
Date of Birth:
Home Phone:
Other Phone:
Social Security #:
Preferred Contact:	Day Phone Evening Phone
2. Employment Information
Company Name:
Company Phone:
Job Title:
Start Date:
Gross Income:
Frequency of Payment:	Every Week Every Two Weeks Once A Month Once A Year
3. Vehicle of Interest
Vehicle Type:	New Used
Vehicle Year:	2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990
Vehicle Make:	Select a Make Coachmen SunValley Vortex Wanderer Coachmen Clipper Jason Truck Caps Continental Cargo Other
Vehicle Model:
Vehicle Mileage:

By completing and submitting the Bill Gardiner RV Online Finance Application, I hereby authorize the dealer, Bill Gardiner RV SuperCenter to verify credit and employment history as stated above and to answer questions about credit experience with me.

If this application is made persuant to any credit program for attendees and/or graduates of schools or educational institutions, then prospective creditors may verify my eligibility for such program, including by inquiry to my school(s) or educational institutions. Insurance related to the credit for which I am applying may be purchased from an insurer or agent of my choice who meets prospective creditors standards.

In connection with this application for credit, prospective creditors may request a consumer (credit) report. On my request, prospective creditors will advise me if the report was actually ordered and if so, the name and address of the agency that furnished the report. Prospective creditors may order subsequent consumer credit reports.

Everything that I have stated in this application is correct to the best of my knowledge . I understand that prospective creditors will retain this application whether or not it is approved. I will notify prospective creditors, if applicable, within a reasonable time of any change in my name, address or employment.

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