EASTER’S INC
                                      8100 Fairystone Park Hwy Bassett VA 24055
                                                 276-629-4777 or 276-627-8650
                                                          Fax: 276-629-1390


                                                     Credit Application
   BUSINESS CONTACT INORMATION


    Full Name of Company: ________________________________________________________________

    Address: ____________________________________________________________________________

    Phone: ___________________Fax:_________________Email:_________________________________

    Year Organized: ____________________________Person to Contact: __________________________

    You’re Name: ________________________________________________________________________

    Title: ________________ Form of Organization: ____________________________________________

    Federal I.D:____________________

    Sole proprietorship: ____________________ Partnership:_____________ Corporation:_____________

    PERSONAL GUARANTOR

    Name: _______________________________________________________________________________

    Address: _____________________________________________________________________________
   
    Social Security: _______________________Date of birth: __________________U.S. Citizen: ________

    Telephone: _______________________________ Fax: ________________________________________

    Cell phone number: _____________________________E-mail: __________________________________

    Bank name: ___________________________________________________________________________

    Bank address: _________________________________________________________________________
 
    Phone: ________________________________________________________________________________

    Mortgage with: _________________________________ Monthly payment: _______________________

    Employer: __________________________________ Position : __________________________________

    Address: ______________________________________________________________________________

    Employer number: ___________________ How long: __________________________________________

    Additional income per month: _____________________________________________________________

    SPOUSE OR ADDITIONAL GUARANTON


    Name: ________________________________________________________________________________

    Address: ______________________________________________________________________________

    Social Security: _______________________ Date of birth: ________________U.S. Citizen: __________

    Telephone: _____________________________ Cell phone number: _____________________________

    Fax: ________________________________ Email : __________________________________________

    Social Security: ________________________ Date of birth: ___________________________________

    Employer: ____________________________________________________________________________

    Address: _____________________________________________________________________________

    Phone: ________________________________Additional income per month: ______________________

    Bank name: __________________________________________________________________________

    Bank Address: ________________________________________________________________________

    Mortgage with: _______________________________________ Monthly payment: ________________

    Primary Bank: _________________________________________________________________________

    Contact: _____________________________________________________________________________

    CREDIT REFERENCES

    Creditor: _____________________________________________________________________________

    Contact: ______________________________ Phone : ________________________________________

    Creditor: _____________________________________________________________________________

    Contact: ______________________________ Phone : ________________________________________

Vehicle Information you are interested in
      Year______ Make_______________ Model____________ Price wanting to spend_________________
Down payment______________________

    FAIR CREDIT REPORTING ACT AUTHORIZATION
 For the purpose of securing credit from you, I certify that the above information is true and
complete to the best of my knowledge Applicant authorizes you to check my credit and employment history
 and to provide and / or obtain information about credit experience with Easter's INC.

    Applicant Signature: _______________________________________________________Date :______

    Joint Applicant Signature: __________________________________________________Date:_______