If you would like a version of this form to print out and mail or fax to Marshall Machinery, click here.
| Email address: |
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| Federal Tax ID or SSN: |
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| Date of Birth: |
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| First Name: |
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| Middle Initial: |
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| Last Name: |
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| Business Name: |
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| Street Address: |
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| City: |
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| Home Telephone: |
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| Business Telephone: |
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| Yrs at Residence: |
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| Type of Residence: |
Own
Rent
Lease
Board
Other
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** Please complete mailing address
if different from street address above: |
| Mailing Address: |
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| City: |
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| State: |
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| Zip Code: |
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** If at address less than 3 years,
Please indicate you previous address: |
| Street Address: |
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| City: |
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| Employer Name: |
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| Employer Address: |
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| City: |
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| Work Telephone: |
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| Position: |
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| Years on Job: |
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| Gross Monthly Salary: |
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| PREVIOUS EMPLOYER INFORMATION |
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| Employer Name: |
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| Employer Address: |
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| City: |
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| Work Telephone: |
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| Years on Job: |
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| Gross Monthly Salary: |
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| BUSINESS OR AGRICULTURAL INFORMATION: |
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| If you are self-employed, what is your type of business? |
Propreitorship
Partnership
Corporation |
| Business Activity: |
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| Number of years farming: |
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| Total Number of Acres: |
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| Type of livestock or crops: |
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| Est. Annual Farm Income: |
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| Market Date: |
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| OTHER INCOME: |
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| (Alimony, child support or separate maintenance payments need not be disclosed unless relied upon for credit worthiness) |
| Source of other income: |
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| Gross Monthly Amount: |
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| REFERENCES: |
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| Nearest relative not living with you |
| Name: |
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| Relationship: |
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| Address: |
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| City: |
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| BANK INFORMATION: |
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| Name: |
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| Address: |
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| City: |
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| Telephone: |
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| Contact Name: |
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| LANDLORD/MORTGAGE INFORMATION: |
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| Name: |
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| Amount: |
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| Address: |
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| City: |
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| Zip: |
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| Telephone: |
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| Contact Name: |
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| OTHER LENDER(S): |
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| Lender 1: |
| Name: |
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| Amount: |
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| Address: |
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| City: |
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| State: |
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| Telephone: |
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| Contact Name: |
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| Lender 2: |
| Name: |
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| Amount: |
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| Address: |
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| City: |
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| Telephone: |
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| Contact Name: |
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| Please Indicate which of the following apply to you: |
Financed With Kubota Corp.
Had a repossession
Been sued
Filed bankruptcy
Been subject to a tax lien
Had a foreclosure
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NOTICE TO MAINE RESIDENTS: If this application is approved by the creditor, you will be required to obtain and maintain physical damage insurance on the collateral securing the debt. You have the right of free choice in the selection of the agent and insurer through or by which the insurance is placed. NOTICE: Consumer reports (credit reports) may be obtained in connection with this application. If you request, 1) you will be informed whether or not consumer reports were obtained; and 2) if reports were obtained, you will be informed of the name and address of the consumer reporting agencies (credit bureaus) that furnished the reports.
NOTICE TO NEW YORK RESIDENTS: A consumer credit report may be requested in connection with this application or in connection with any renewals or extensions of any credit granted as a result of this application. If you subsequently ask for this information, you will be informed whether or not such a report was requested and if so, the name and address of the agency that furnished the report.
NOTICE TO OHIO RESIDENTS: The Ohio laws against discrimination require that all creditors make credit equally available to all credit worthy 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.
NOTICE TO UTAH RESIDENTS: As required by Utah law, you are hereby notified that a negative credit report reflecting on your credit record may be submitted to a credit reporting agency if you fail to fulfill the terms of your credit obligations.
NOTICE TO WISCONSIN RESIDENTS: No provision of a marital property agreement, a unilateral statement under WlS.STAT.SEC 766.59 or a court decree under WIS.STAT.SEC 766.70 adversely affects the interest of the creditor unless the creditor, prior to the time the credit is granted, is furnished a copy of the agreement, statement or decree or has actual knowledge of the adverse provision when the obligation to the creditor is incurred.
I HEREBY CERTIFY THAT THESE STATEMENTS ARE CORRECT TO THE BEST OF MY KNOWLEDGE AND ARE MADE FOR THE PURPOSE OF OBTAINING FINANCING FROM KUBOTA CREDIT ORPORATION, U.S.A. I AUTHORIZE YOU TO OBTAIN ANY INFORMATION INCLUDING BUT NOT LIMITED TO CREDIT REPORTS WHICH YOU MAY REOUIRE CONCERNING THIS APPLICATION AND I AGREE THAT THIS APPLICATION SHALL REMAIN YOUR PROPERTY, WHETHER THE FINANCING IS GRANTED OR NOT.
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