Date:    7/3/2008    

 *Applicant Name

 
 *Applicant Email Address  *Social Security #  *Birthday (mm/dd/yyyy)  *Phone Number

 

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 *Present Address  *City  *State & Zip  *How Long (# Months)
     ,   Months
 Former Address  City  State & Zip  How Long (# Months)
     ,   Months
 *Employer  *Phone Number  *How Long (# Months)
      Months
 *Position  Other Income ($)  *Income ($/Month)
     
 Other Income - Description   
   
 Previous Employment/ Occupation  Phone Number  How Long (# Months)
      Months
 *Living Arrangement  Land Lord (Rent) / Bank (Own)
Rent Parents
Own Other
Buy
 Name    Phone  
 Address    State  
 City    Zip  
 Amount Per Month ($)
 
 Saving Bank  *Checking Bank
   
 *Co-Applicant Name  *Social Security #  Birthday (mm/dd/yyyy)  *Phone Number
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 *Present Address  *City *State & Zip  How Long (# Months)
     ,   Months
 *Employer  Phone Number  How Long (# Months)
      Months
 Position  Other Income ($)  Income ($/Month)
     
 Other Income - Description   
   

Trailer Purchased

Down Payment Information
   
*Stock #  
Year  
Make  
Model  
Trade In Yes  |No
Trade In
Description		  
  # Horses, Condition, etc...
   
*Cash Price (Incl. tax, title, doc. fee)...... $
Customer Cash ......................................... $
Factory Cash Rebate .............................. $
Dealer Cash Rebate ............................... $
Trade-In Allowance ................................ $
Less Lien ................................................ $
Not Trade-In Allowance ......................... $
*Total Down Payment ............................ $
*Amount to Finance  ............................. $
   
Dealer Information
 Dealer Name: Midway Trailer Sales
 Contact Person: Randy McNutt
 Phone Number: (800) 659-4051
 Fax Number: (815) 434-1864          E-Fax: (775) 522-0361

* Signifies Required Field