Financing

PLEASE TELL US ABOUT YOURSELF

Email address (required for quick response) Tell us what you would like to purchase. Have you spoken with anyone about our product yet? (Kyle, Chris, Craig or "Don't know") Print your full name (First, Middle Initial, Last) Social Security # Date of Birth Drivers License or State ID# Street Address City State Zip Code Home Phone How Long Have You Lived There? Monthly Payment or Rent Own Rent Previous Address City State Zip Code How Long Current Employer Phone Gross Monthly Income Position How Long Have You Worked There? Type of Other Income* Amount* * Alimony, child support and/or separate maintenance income need not be revealed if you do not wish it to be considered as a basis of repayment. Previous Employer (if less than 2 years at current employer) How Long

JOINT/CO-SIGNER APPLICATION INFORMATION

Joint/Co-Signer Applicant (J/A) full name: (First, Middle Initial, Last) Social Security # Date of Birth Drivers License or State ID # Relationship (if any) Address (if different from primary) City State Zip Code Home Phone How Long Have You Lived There? Monthly Payment or Rent Own Rent J/A Employer Phone J/A Income Position How Long Have You Worked There? Type of Other Income* Amount* * Alimony, child support and/or separate maintenance income need not be revealed if you do not wish it to be considered as a basis of repayment.

I hereby certify that the above information contained in this Customer Statement - Credit Application is complete and accurate to the best of my knowledge