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Credit Application Form
Please Print this form and
Mail or fax to:
Anglers Marine
3475 E. La Palma Avenue,
Anaheim, CA 92806
Fax No.
714-666-0965
Please print with black ink
Full Name____________________________ Social Security Number____________________ Date of Birth__________
Spouse's Full Name____________________ Social Security Number____________________ Date of Birth__________
Home Address_____________________________City________________________State_______Zip Code_________
How long have you lived at the above address Years_______ Months_______ Home Phone # ____________________
Do you Rent or Own?___________________ Monthly Payment _______________________
Have you ever filed Bankruptcy? _______________________ if yes, when ___________________________________
Mailing Address____________________________City________________________State_______Zip Code_________
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Your Employer Information
Present Employer (type of business if self-employed)___________________________________________________
Employers Address ________________________City________________________State_______Zip Code_________
Your Position_____________________________________ How Long at this job Years________ Months__________
Employers Phone number __________________________Gross Monthly Income _______________
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Spouse's Employer Information
Employers Address ________________________City________________________State_______Zip Code_________
Spouse's Position__________________________________ How Long at this job Years________ Months__________
Employers Phone number __________________________Gross Monthly Income _______________
Total household monthly income $___________________
I/WE GIVE THE ABOVE INFORMATION FOR THE PURPOSE OF OBTAINING CREDIT AND
AUTHORIZE ANGLERS MARINE (DEALER) TO OBTAIN INFORMATION CONCERNING ANY STATEMENTS
MADE HEREIN. I AUTHORIZE THE BANK TO CONTACT ME AT ANY TELEPHONE NUMBERS
PROVIDED, LISTED IN MY NAME OR IN THAT OF ANY FAMILY MEMBER OR PROVIDED TO
THE BANK BY ANY OTHER PERSON.
X____________________________________________ Date____________
Purchaser's Signature
X____________________________________________ Date____________
Purchaser's Signature
This form is in printable form only to provide you with the highest level of security
Please mail to Anglers Marine at the address listed above. If you choose to E-Mail
this form we can not be responsible for security while in transit over unsecure
Internet lines.
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