CJ Jernigan Finance Application

Step 1 of 4 - Purpose

Company
This field is for validation purposes and should be left unchanged.
Equipment To Purchase*
Dealer Name
Cost*
Who Refered You?

Lender
City
US State
Customer Since
Loan Account #
Amount Financed
Phone
Contact
*
- By Checking I Agree To The Following
Signature (Type Name)*
I/We the undersigned are applying for credit from Montana Commercial Credit, Inc. and / or its assigns. I/We understand and agree that you may assign or transfer this credit application to others to decide whether or not to extend credit. I/We authorize you to pull credit reports, request bank, finance, employment references, landlords and any past or present creditors to give any and all information to Montana Commercial Credit, Inc. and /or assignees. This Authorization extends to lending sources to whom we submit your credit request and application. This shall be a continuing authorization for all present and future disclosures of account information. In addition, I authorize the photocopying of my driver’s license for verification purposes. EQUAL CREDIT OPPORTUNITY ACT. If your application for business credit is denied, you have the right to a written statement of the specific reasons for the denial. To obtain the statement, please contact Montana Commercial Credit, 1106 Central Avenue, Great Falls, MT 59405, (406) 268-9840 within 60 days from the date you are notified of our decision. We will send you a written statement of reasons for the denial within 30 days of receiving your request for the statement. NOTICE: The federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); because all or part of the applicant’s income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning this creditor is the Federal Trade Commission, Equal Credit Opportunity, Washington, DC 20580.

Name	Title	% Ownership	Date of Birth	SS#	Address	City	State	Zip	Phone