Spaudling Car 1
 

HARDKNOCK WHEELS CREDIT APPLICATION

 
Individual Credit
Joint Credit
Amount Requested
Purpose of Loan

How did you hear about us?
 
Applicant Name (Last, First, Middle)
 

Rank/ Pay Grade Social Security Number

 
Present Address (Street, City, State, Zip Code)
 
Qtrs.              Barracks/Ship            Rent            Own           Date of Birth  How Long?
 
Phone (include overseas prefixs/area code) Rent/Mortgage Pmt. $  How many children?
 
State of Legal Residence Prior Duty Station  Number of Years in Service
 
Number of Years in Reserves Number of Years in Service
 
Home of Record Address (Street, City, State, Zip Code)
 
Phone (area code) Email Address
 
Branch of Service DOS ETS EAS EAOS Date
 
Rotation/Transfer Date Present Military Unit or Current Command
 
Phone (area code) MOS/Rating/Division
 
Supervisor, NCOIC or LPO Phone (area code) 1SG or LCPO
 
Phone (area code) Have you ever filed bankruptcy? Yes No
 If "YES" Month/Year Filed and Bankruptcy Discharge Date:
Spouse/CO Applicant Name(Last, First, Middle)
If Active Duty, Pay Grade/ETS Social Security Number
Present Address (Street, City, State, Zip Code)
Date of Birth Employer Name and Phone Number (area code)
Address (Street, City, State, Zip Code)
Position Length of Employment Income$ Month Year
Bank Name Bank Location (City, State)
Automatic Deposit Goes Into Checking Savings        Automatic Deposit Account#
List Automibles Monthly Payment Make/Year/Model
Insurance Payment Amount$  Month Year
 
All OPEN accounts, debts and liabilites must be disclosed.  List All allotments shown on LES and where they are going, including Bank, Credit Union, Savings or Discretionary.
       
1. ALLOTMENT/EFT/OPEN ACCT.      PAYMENT $      BALANCE $
2. ALLOTMENT/EFT/OPEN ACCT.      PAYMENT $      BALANCE $
3. ALLOTMENT/EFT/OPEN ACCT.      PAYMENT $      BALANCE $
4. ALLOTMENT/EFT/OPEN ACCT.      PAYMENT $      BALANCE $
5. ALLOTMENT/EFT/OPEN ACCT.      PAYMENT $      BALANCE $
6. ALLOTMENT/EFT/OPEN ACCT.      PAYMENT $      BALANCE $
7. ALLOTMENT/EFT/OPEN ACCT.      PAYMENT $      BALANCE $
8. ALLOTMENT/EFT/OPEN ACCT.      PAYMENT $      BALANCE $
9. ALLOTMENT/EFT/OPEN ACCT.      PAYMENT $      BALANCE $
 
Child Support Amount$ Advance Pay Amount$ DPP or NEX Amount$

RELEASE AUTHORIZATION & CERTIFICATION OF MILITARY STATUS    I (Applicant) am applying for a loan with Pioneer military Lending under me provision or section 552a (b) Public Law 93-579, commonly known as the Privacy Act., Dept. of Defense 5400.11 enc 5. Par 3-2 apr 340 - 21 Dept. of the Army, 27 August 1975 Section C, Par 24 AFR 12 - 35, Dept. of the Air Force Par 7a(1), SECNAVINST 5211.5 Dept. of the Navy 14 August 1975. I understand that the Lender will not contact my Commanding Officer in connection with this debt unless I specifically give the Lender prior consent to make such contact. With full knowledge and understanding of this right, I hereby consent to contacting my Commanding Officer/Personnel Officer and/or Custodian of my official records to obtain my current military and/or civilian address even though I may be discharged and/or retired from military service. I also consent to you contacting my Commanding Officer in connection with the collection of the loan made hereby at any time when it is in default and until such time as the loan has been paid in full.

PLEASE CHECK THE BOXS BELOW:

I have not voluntarily applied for, nor have pending at the present time, an early release from the military.

I do not have any disciplinary or court martial action on my record or pending.

I am not barred from re-enlistment.

I hereby declare that all such statements and answers are correct and I hereby authorize you to verify any of the above         information furnished therein.

Date Applicant Co-Applicant

 


     
   
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