BURT LAKE MARINA ph: 231-238-9315 service since 1969

Please fill out the form below and we will contact you.

APPLICANT

Last Name:

First Name:

Social Security #:

Drivers License #:

Address (include street, city & zip):

Time at Address:

County:

Phone #:

E-mail:

Birth Date:

Housing:

Mortgage holder
or Landlord

Monthy Payment $:

Place of Employment

Occupation

Supervisor

Work Phone

Length of Employment:

Gross Income before taxes:

CO-APPLICANT (optional)

Last Name:

First Name:

Social Security #:

Drivers License #:

Address (include street, city & zip):

Phone #:

Birth Date:

Place of Employment

Length of Employment:

Gross Income before taxes:

Nearest Relative, not living in household

Name

Relationship

Address (include street, city & zip):

Phone Number

Product Purchasing

Make:

Model:

Year:

Down Payment:

By checking yes in this box I am giving permission to Burt Lake Marina to pursue credit for this purchase on my behalf.
Any Comments or Questions:

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