Credit Application

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Credit Application
NOTE: We understand that privacy is important to you, therefore this information
will NOT be sold to outside pa

Salesperson you are working with:
Name of Purchaser:	Name of CO-Purchaser:
Current Address: Street: City: Zip:	Current Address: Street: City: Zip:
Home Phone #: Work Phone #: Cell Phone #: Fax #: E-Mail:	Home Phone #: Work Phone #: Cell Phone #: Fax #: E-Mail:
Social Security # Date of Birth:	Social Security # Date of Birth:
Current Employer: Start Date: Current Income: Previous Employer: Start Date: End Date:	Current Employer: Start Date: Current Income: Previous Employer: Start Date: End Date:
Are you a Veteran? Are you a Disabled Veteran? Date of Discharge:	Are you a disabled Veteran? Are you a Disabled Veteran? Date of Discharge:
Do you have any of the following: Bankruptcy (within the last 2 years): Federal Debts: Foreclosure: Lien: Defaulted Student Loan:	Do you have any of the following: Bankruptcy (within the last 2 years): Federal Debts: Foreclosure: Lien: Defaulted Student Loan:

Authorization/Disclosure/Disclaimer

The Federal Fair Credit Reporting Act allows you to obtain a copy of your consumer credit report from any consumer credit reporting agency for a reasonable charge. The FCRA also states that individuals are entitled to receive a disclosure directly from the consumer credit reporting agency free of charge under the following circumstances:

You have been denied credit, insurance or employment in the past 60 days as a result of your report
You certify in writing that you are unemployed and intend to apply for employment in the 60-day period beginning on the day you make the certification
You are a recipient of public welfare assistance
You have reason to believe that your file at the agency contains inaccurate information due to fraud

The Act also permits consumers to dispute inaccurate information in their credit report without charge. Accurate information cannot be changed.

I certify that I am the person named above and that all information listed above is accurate and complete. I authorize Luke Group Inc. (LukeGroup.com) to access my report.

Note: Before you click the "Accept" button, please review the information you have entered for accuracy and completeness. Some browsers, such as Internet Explorer, will clear the information from all fields once you submit the form. If you need to return to the form to correct a field, you will have to reenter all of the information.

I accept the terms of the Authorization/Disclosure/Disclaimer. Please evaluate my credit and run a credit report.

Clear the information entered in the form.

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	I accept the terms of the Authorization/Disclosure/Disclaimer. Please evaluate my credit and run a credit report.
	Clear the information entered in the form.