CO-APPLICANT INFORMATION (For Joint Applications Only)
 
Check if you are NOT a US Citizen         
 
Social Security Number                                                              Date of Birth                    No. of Dependents
 
First Name             Middle      Last Name
 
Residence Address (No PO Box allowed)                   Time at Residence
                                                   Yrs.              Mos. 
 
City                   State       Zip
 
Home Phone Number                 Cell Phone Number
            /              /                              /              /
 
E-Mail Address:
 
Present Employer                                     Work Phone Number
                                                                 /              /
 
Occupation                                                       Gross Monthly Salary          Length of Employment
                                                 $             Yrs.    Mos.
 
Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
 
Other Income        Source                          Monthly Amount
$                                          $
 





Dealer #________________________________________________________________________________
Initial Sale $_______________________________Down Payment $________________________________

By signing this application: 1) you warrant all information you provide is true and complete; 2) you authorize Dealer to assign this application to Aqua Finance, Inc. or its assigns; 3) you authorize a full investigation and release of any records from any source, including credit bureau reports, to check the accuracy of information on this application; and 4) you consent to receiving autodialed message calls from us or our agents on your wireless phone. You have a continuing duty to keep us informed if any information on this application changes. By completing and signing this application you understand that you have requested that we open a revolving credit account which allows you to make credit purchases on account as evidenced by a revolving credit sales slip, and you agree to all the terms and conditions of this Revolving Credit Agreement. By your signature you acknowledge that you have received and read all the terms of this Agreement before making any purchases on the account. IF THIS IS A JOINT ACCOUNT YOU UNDERSTAND THAT EACH APPLICANT HAS THE RIGHT TO USE THE ACCOUNT TO THE CREDIT LIMIT AND THAT CO-APPLICANTS ARE JOINTLY AND SEVERALLY LIABLE FOR ALL PURCHASES ON THE ACCOUNT. See State Notices for important information regarding this credit application and agreement. No agreement exists between us until this application is approved. 
SOCIAL SECURITY NUMBER/TAXPAYER IDENTIFICATION NUMBER:  Under penalties of perjury, I certify that: 1)The number shown on Page 1 of this Credit Application is my correct taxpayer identification number (or I am waiting for a number to  be issued to me),  2) I am not subject to backup withholding because: (a) I am exempt from backup withholding; or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends; or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3) I am a U.S. person (including a U.S. resident alien). Certification Instructions: Cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return.  Cross out item 3 and complete a W-8 BEN if you qualify and are not a U. S. Person.
The Internal Revenue Service does not require your consent to any provision of this document other than the certification required to avoid backup withholding.
Your Minimum Monthly Payment will be between 2% and 5% of the �Highest Monthly Charge� balance since your Monthly Charge Balance was zero (less any Special Payment Plans) as will be shown on your billing statement, rounded to the next highest dollar, or $15, whichever is greater.  A finance charge will be computed on your outstanding balance each month.
DO NOT SIGN BELOW UNLESS MERCHANT HAS PROVIDED THE ATTACHED DISCLOSURES AND TERMS. BY YOUR SIGNATURE BELOW YOU ACKNOWLEDGE RECEIPT OF THE ATTACHED REVOLVING CREDIT AGREEMENT.

APPLICANT INFORMATION (Please Type or Print Clearly)
 
Check if you are NOT a US Citizen         
 
Social Security Number                                                              Date of Birth                    No. of Dependents
 
First Name             Middle      Last Name
 
Residence Address (No PO Box allowed)                   Time at Residence
                                                   Yrs.              Mos. 
 
City                   State       Zip
 
Home Phone Number                 Cell Phone Number
            /              /                              /              /
 
E-Mail Address:
 
 Own           Monthly Mortgage Payment             Home Value                                           
 Rent           $                     $                                                                
 
Present Employer                                     Work Phone Number
                                                                 /              /
 
Occupation                                                       Gross Monthly Salary          Length of Employment
                                                 $             Yrs.    Mos.
 
Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it consid�ered as a basis for repaying this obligation.
 
Other Income        Source                          Monthly Amount
$                                          $
 
PERSONAL REFERENCE (Not Living With You)
 
Name
 
Relationship                                    Phone Number
                                                   /              /
 



Applicant Signature                              Date              /           /
 
Applicant Driver�s Lic. No.                    State Issued    Expiration Date
          /           /
 
Joint Applicant Signature                            Date              /           /
 
Joint Applicant Driver�s Lic. No.                  State Issued    Expiration Date
          /           /