Goldmark Industries Lease Application

Personalizing System $7995 USD
Applicant E-Mail
Important: Enter a valid e-mail address. Correspondence will be sent to this address.
*E-Mail:         
Applicant Information
*Type of Credit:       
Individual
Joint
 
   
*First Name:       
Middle Initial:       
*Last Name:       
*Address Line 1:       
Address Line 2:       
*City:       
*State/Province:       
*Zip/Postal Code:       
*Home Phone:       
*Work Phone:       
Cell Phone:       
*Years at Current Address:       
*S.S.N./S.I.N.      
*What is your marital status?       
Single
Married
Divorced
Widowed
 
Co-Applicant Information
First Name:       
Middle Initial:       
Last Name:       
Address Line 1:       
Address Line 2:       
City:       
State:       
Zip Code:       
Home Phone:       
Work Phone:       
Cell Phone:       
Years at Current Address:       
*S.S.N./S.I.N.    
What is your marital status?       
Single
Married
Divorced
Widowed
 
Financial Information (Applicant)
*Mortgagee/Landlord Name:       
*Mortgagee/Landlord Phone:       
*Current Mortgage/Rent:       
Current Mortgage Balance:       
*Current Occupation:       
*Current Employer or Business Name:       
*Business Address:       
*Position Held:       
*Start Date:       
*Monthly Income:       
Note: Alimony,child support or separate maintenance income need not be revealed.
Other Income Source:       
Monthly Income:       
Bank Information
*Bank Name:   Account Type:
Checking or Savings Account #: 
Financial Information (Co-Applicant)
Mortgagee/Landlord Name:       
Mortgagee/Landlord Phone:       
Current Mortgage/Rent:       
Current Mortgage Balance:       
Current Occupation:       
Current Employer or Business Name:       
Business Address:       
Position Held:       
Start Date:       
Monthly Income:       
Note: Alimony,child support or separate maintenance income need not be revealed.
Other Income Source:       
Monthly Income:       
Bank Information
*Bank Name:   Account Type:
Checking or Savings Account #: 
 
 
THE UNDERSIGNED CERTIFIES THE ABOVE INFORMATION TO BE TRUE AND CORRECT. I/WE HEREBY AUTHORIZE GOLDMARK INDUSTRIES AND/OR IT'S THIRD-PARTY AGENTS, OR ASSIGNS TO COLLECT, RETAIN, USE, DISCLOSE & EXCHANGE CREDIT REPORTS, BANKING & CREDIT REFERENCES, AND OTHER PERSONAL INFORMATION FOR ALL PURPOSES RELATED TO CONFIRMING IDENTITIES, THE EVALUATION OF CREDIT WORTHINESS, PROVIDING LEASING AND/OR OTHER FINANCIAL SERVICES. THIS INCLUDES ADMINISTERING CONTRACTS, REGISTERING SECURITY INTEREST, PERFORMING INTERNAL STATISTICAL ANALYSIS, REPORTING ACCOUNT INFORMATION TO CREDIT AGENCIES AND OTHER CREDITORS, AND OR OTHER PURPOSES AS REQUIRED OR PERMITTED BY LAW.
I understand any false or misleading statements in my application may cause
any loan to be in default. I agree that this application shall be this
Institutions`s property whether or not this credit application is approved.
By signing below, I agree to all of the terms and conditions stipulated on this application.
*Signature Applicant:         
*Signature Co-Applicant:         
*Dated:       
Please Fax to: 317-574-0877