Credit Application
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Sale Amount
*
Sales Representative
*
Applicant Name
*
First
Last
Date of Birth
*
Phone Number
*
Email
*
Social Security Number
*
Water Treatment
Well Water
City Water Kit (With Soaps)
City Water Kit (No Soaps)
City Water
Reverse Osmosis
Softener
Softener Kit (No Soaps)
Other Products
Alkaline Stage
Switch RO
Fence
Air Conditioning
Gutters
Roof
Other
Time at Residence (Months)
*
Rent or own?
Rent
Own
Address
*
Address Line 1
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Mortgage Payment / Rent
*
Employer Name
*
Occupation
*
Time at Current Job
*
Monthly Income
*
Other Income
*
Add Auto Payment?
*
Yes
No
Routing Number
*
Account Number
*
ID Upload
*
Click or drag a file to this area to upload.
Applicant's Signature
*
Add Co - Applicant?
*
Yes
No
Applicant Name
*
First
Last
Applicant Date of Birth
*
Applicant Phone Number
*
Applicant Email
*
Applicant Social Security Number
*
Time at Residence (Months
*
Applicant Occupation
*
Applicant Address
*
Address Line 1
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Applicant Mortgage Payment
*
Applicant Employer Name
*
Applicant Time at Current Job
*
Applicant Monthly Income
*
Applicant Other Income
Applicant File Upload
*
Click or drag a file to this area to upload.
Applicant Applicant's Signature
INCOME NOTICE:
*
I'm Agree
You need not disclosure alimony, child support or separate maintenance income if you do not wish to have it considered as a basis for repaying this obligation.
By signing below, you certify that all information given on this application is true and complete. You also authorize us to confirm the information in this application and give out information about you or your account to credit reporting agencies and others who are allowed to receive it.
You authorize and instruct us to request and receive credit information about you from any credit report agency or third party. If we do not approve this application, you request and authorize us to provide this application and credit information to other finance source witch will consider it under their credit standards.
You grant the other finance sources the right to request a consumer credit report on you and authorize them to check your credit and employment history. This is also an authorization for Serrato Water to enter the premises in the address given in this application and install the whole house water conditioning system and reverse osmosis once this application is approved.
Installation and removal charges will occur in case of cancellation after system being installed.
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