Mark Miller Marine 3581 Scottsville Road. Glasgow, KY 42141 Phone: 270-678-3324 Fax: 270-678-3524

Please print this Credit Application and fax it to Mark Miller Marine at 270-678-3524    (A) Tell Us About Yourself ____________________________________    _______    ____________________________________    __________ First Name M. Initial Last Name Sr., Jr., III ________________________________________________________________________________________ Present Address __________________________________________________ _______ _____________________ City State Zip _________________________________________________________ Birthday ______ ______ ____________ Email Address   Month Day Year Do you : [   ]   Own     [   ]   Rent     [   ]   Other ________ $______________ _______________ (Check one) Years at residence Monthly Payment # of Dependents ______ - ________ - __________ ______ - ________ - __________ ______ - ____ - __________ Home Phone Business Phone Social Security Number ____________________________________ ____________ $______ , _______ ____________ Your Employer How Long (yrs) Total Annual Income Previous Employment Time if less than two years    Joint Applicant ____________________________________    _______    ____________________________________    __________ First Name M. Initial Last Name Sr., Jr., III ________________________________________________________________________________________ Present Address __________________________________________________ _______ _____________________ City State Zip _________________________________________________________ Birthday ______ ______ ____________ Email Address   Month Day Year Do you : [   ]   Own     [   ]   Rent     [   ]   Other ________ $______________ _______________ (Check one) Years at residence Monthly Payment # of Dependents ______ - ________ - __________ ______ - ________ - __________ ______ - ____ - __________ Home Phone Business Phone Social Security Number ____________________________________ ____________ $______ , _______ ____________ Your Employer How Long (yrs) Total Annual Income Previous Employment Time if less than two years    (B) Boat You Are Interested In __________________________________________________ ______________________ ___________ Boat Make / Length Boat Model Year    (C) Trade-In Information __________________________________________________ ______________________ ___________ Boat Make / Length Boat Model Year __________________________________________________ ______________________ ___________ Motor Make Motor Model Year Is the Trade-In currently finanaced?      [   ]   Yes    [   ]   No Approximate Balance Owed      $______ , _______    (D) Loan Amount $____________ , ____________ $____________ , ____________ Loan Amount Down Payment    (E) Applicant / Joint Applicant Signatures X_________________________________________ X_________________________________________ ____________ Applicant Signature Joint Applicant Signature Date