Ford Motor Credit Company

Business Credit Application
Commercial Prod.Line
Joint Individual

Dealership: Galpin Motors, Inc.

Sales Person:

Date:

NOTE: Partnerships, Corporations or LLCs complete this section

Corporations or Partnerships submit two year-end financial statements and most current balance sheet and profit/loss on business or current tax return.

Corporation:	C		S		Non-Profit Organization		Partnership
Business Name	Trade Name / DBA					Tax ID Number

Business Address
Street Address 1	Street Address 2	City	County	State	Zip Code

Type of Business

State of Organization

Date Business Established

Business Phone Number
( )

Monthly Income

Email Address

Principal Name (1)	Title	% Owned
Principal Name (2)	Title	% Owned
Principal Name (3)	Title	% Owned

* if more than three Principals, please attach seperate sheet listing information

NOTE: Individual, Guarantor, Sole Proprietorship complete this section

Name (First, MI, Last, Generation)
Soc. Sec. No.	Date of Birth	Personal Email Address
Other Name(s) under which applicants credit references or history can be found

Present Address
Street Address 1	Street Address 2	City	County	State	Zip Code

Billing Address
Street Address 1	Street Address 2	City	County	State	Zip Code

Home Phone Number
( )

Company Name

Company Phone Number
( )

Cell Phone Number
( )

Driver License#

Driver License State

Time on Job (Mos.)

Own Home Outright		Living with relatives
Buying Home		Leasing / Renting			Lived There Yrs Mos.	Mo. Pmt $

Mortgage Holder/ Landlord (Name & Address)	Banking Reference	Acct. No.
Name & Address of Applicant's nearest relative not in household	Relationship	Homephone ( )
Name & Address of Applicant's personal reference known over 1 year		Homephone ( )

* 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.

Secondary Income

Source

Gross Monthly Income

Previous Employer/Contractor (if less than 2 years)

Address

Phone
( )

How Long

FC 7144 April 03 Previous editions may NOT be used.

Business Information (Check each item that is most applicable to your employment/intended use of your vehicle)

Business

Agricultural

Hazardous

Local

Interstate

Intermediate

List any Automotive Financing/Leasing Sources, Banking References and Lines of Credit

Financial Institution	Address	Acct. No.	Unpaid Balance	Contact	Phone

Transaction Information (Dealer to complete)

Dealer Information
Contact Name	Contact Phone No.	Dealer No.

Vehicle Information
Invoice Amount	Cash Price .	Cash Down
Trade-in Amount	Amount Owed on Trade	Estimated Payment

No. Units

New/Used

Year

Vehicle Type

Make/Model

Trade-in Description

Term

California Disclosure
Applicant, if married, may apply for a separate account.

Maine Resident
If your credit application is approved and you finance the purchase of your motor vehicle through Ford Credit, you will be required to insure the vehicle against loss or damage. Ford Credit requires collision coverage and comprehensive coverage or fire and theft coverage. In addition, if this application is for a lease, Ford Credit will also require you to obtain liability insurance. You have the option to select an agent or broker of your choice, whether or not affiliated with Ford Credit. Obtaining insurance from a particular agent or broker does not affect credit decisions by Ford Credit, unless the insurance product selected violates the terms of your contract for the purchase or lease of the motor vehicle.

Ohio Disclosure
The Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy customers and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law.

Rhode Island Resident
A Credit Report may be requested in connection with this application for credit. Vehicle insurance may be obtained from a person of your choice.

Tennessee Resident
You must maintain insurance during the term of the contract. You must give the creditor evidence of this insurance. The amount and type of insurance must be acceptable to the creditor. YOU MAY CHOOSE THE PERSON THROUGH WHOM ANY INSURANCE IS OBTAINED.

Vermont Resident
By signing this credit application, Applicant consents to your obtaining a credit report for the purposes of evaluating this application and to obtain subsequent credit reports, in connection with this transaction, for the purpose of reviewing the account, taking collection action on the account or for any other legitimate purpose associated with the account.

For the purpose of securing credit from you, I certify that the above information is true and complete to the best of my knowledge. I authorize you to check my credit and employment history and to provide and/or obtain information about credit experience with me.

Applicant Signature:		Title		Date
Joint Applicant Signature:		Title		Date

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