Seller: Location:
Credit Line Requested: Salesperson #:
Approval # Account Number
A married person may apply for individual credit.

Complete each block, print and sign application, and send it to us via
 Fax (305) 829-1061 or E-mail sales@climacontrol.net

Applicant's Name (First, Middle, Last)
Social Security #
Date of Birth
Current Address
City
State
Zip Code
Home Phone
E-mail
Applicant	Rents Owns/Buying
Time at Address	Years Months
Monthly Rent or  Mortgage Payment:

IF APPLICANT OWNS OR IS BUYING:
Current Home Value: Mortgage Balance:

Previous Address: (If less than 2 years at present address)

Street Address
City
State
Zip Code
Home Phone
E-mail

Nearest Relative Not Living With you: (Relationship)

Name
Street Address
City
State
Zip Code
Home Phone
E-mail

Employment Information:

Employer Name
Position
How Long
Gross Monthly Income
Business Phone
E-mail

Financial Information:

Joint Applicant Information:

Name
Street Address
City
State
Zip Code
Home Phone
E-mail

Joint Applicant Employer Information:

Name
Work Phone

Signature of Applicant:

Drivers License No.

Signature of Joint Applicant:

Driver's License (Joint Applicant:

Comments: