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Please note: We do not accept applications for loan amounts under $25,000

You Are:
Anticipated Closing Date: / /

APPLICANT PERSONAL INFORMATION

Full Name: First: MI: Last:
Address:
Street #Street NameStreet Type
City: State: Zip: -
Residential Status: Res. Payment: $
Value of Residence: $ How Long? Years: Months:
Home Phone: ()- Cell Phone: ()-
Email Address: (ex. johndoe@aol.com)
Date of Birth: // Social Security #: --
Marital Status: # of Dependents: Are you a US Citizen?:
Employer: Occupation: Type:
Employer Address:
Street #Street NameStreet Type
Employer City: State: Zip: -
Employer Phone: ()- Ext.: Years There: Months:
Annual Salary: $. Enter your yearly salary only
Other Income: $. Description:
Other Income: $. Description:
Bankruptcy?: If Yes, What Year?:


BOAT INFORMATION

Boat Use: Boat Is: Type of Boat:
Boat Make: Boat Model: Boat Year:
Boat Material: Type of Engine(s): Boat Length: ft
Number of Engines: Engine Horsepower: (each)
Engine Fuel: Engine Make: Engine Year:
Trailer Included:
Sseller/broker/dealer: Seller is:
Seller Full Name: First: MI: Last:
Seller Address:
Street #DirectionStreet NameStreet TypeApt. #Rural Route
Seller City: State: Zip:
Seller Cell Phone: Seller work Phone
Purchase Price: $.
Sales Tax: $. Sales Tax Rate: .%
Down Payment: $. (Cash and Trade In)
Loan Amount Requested: $. Term Requested:


Preferred Contact Method:
How did you hear about us?



Individual - I am applying for an individual account in my own name and am relying on my own income and assets, and not the income or assets of another person, as the basis of repayment of the credit requested.
Joint - We are applying for joint credit, and are relying on our joint income and assets as the basis for repayment for the credit requested.

ACKNOWLEDGEMENT

I (we) authorize and acknowledge that consumer credit reports and employment history reports about me will be requested by Diemen Financial and third parties in connection with this application and/or on an ongoing basis in connection with updates, renewals, extensions or enforcement of any credit granted as a result of this application. I (we) certify that all of the information in this application is complete and accurate to the best of my (our) knowledge. Third party creditors will rely on this application in deciding whether to grant the credit request. I (we) authorize the sharing of information obtained in connection with this credit request, and any resulting loan, between Diemen Financial and any third party creditor that evaluates the credit request. I (we) agree that this application shall be and remain the property of Diemen Financial and any third party creditors that evaluate this credit request, whether or not this application is approved. Please note that alimony, child support or separate maintenance income need not be revealed if it is not to be considered as a repayment source for the loan. In compliance with recent federal legislation, we will be verifying pertinent information which will enable us to confirm your identity.


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