Contact
Credit Applications
Employment
Divine's Auto Centers, Towing and Fasmarts
Credit Application
Applicant Info
Application Type
Please choose an application type.
Joint
Individual Account
Account Type
Please choose an account type.
Home Heating Oil
Auto Repair
Towing
Fuel
Other
Account Type Other
Amount
Store Preference
Applicant's Name
Social Sec No.
Date of Birth
Residence
How Long
Residence Type
Please choose a residence type.
Own
Rent/Lease
From whom
Home Phone
Work Phone
Cell
Employment and Spouse's Information
Applicant's Employer
Occupation
How Long Employed
Salary
Former Employee
Other Sources of Income
Amount
Spouse's Name
Date of Birth
Spouse's Employer
Spouse's Social Sec No.
Bank Information
Bank
Branch
Checking Account
Savings
Credit Established With
Company
Account No.
Company
Account No.
Company
Account No.
Nearest relative not in the household
Address
Signature and Date
I HEREBY AUTHORIZE DIVINE'S TO VERIFY THE INFORMATION ON MY APPLICATION THROUGH THE CREDIT BUREAU. I UNDERSTAND THAT DIVINE'S HAS THE RIGHT TO DENY OR ACCEPT MY APPLICATION FOR CREDIT. IN THE EVENT THAT DIVINE'S AGREES TO EXTEND CREDIT, I AGREE TO PAY BACK THE AMOUNT OF THE DEBT IN FULL. IF MONTHLY PAYMENT ARRANGEMENTS HAVE BEEN MADE, PAYMENTS ARE DUE BY THE 10TH OF EVERY MONTH. A FINANCE OR SERVICE CHARGE OF 1.5% (18% ANNUALLY) ON ALL UNPAID INVOICES.
Applicant's Signature
Date