CREDIT APPLICATION – Clean and Natural Water

Application Date *

Down:

Personal Data *

First

Middle

Last

Driver's License or Legal ID *

(State ID / US Military ID / U.S. Passport) Please send digitized ID to: info@bluewateralkaline.com

ID issue date *

ID expire date *

ID issue state: *

Date of birth *

SSN # *

Home phone *

Cell phone *

Best time to call

Email *

Address *

Address Line 1

Single Line Text

Address Line 2

City *

State *

ZIP Code *

Type of residence: *

Own
Rent

Mortgage / Rent payment:

Time at address (Years): *

Years

Months *

Months

Spanish paperwork

Self-employed: *

App. Employer: *

App. Position:

Employer phone: *

Monthly income: *

Employed since: *

Other income:

Retirement:

Rental:

Investment:

Other:

Applicant Signature: *

Application Completed by: *

Name

By signing this application: 1) You warrant all information you provide is true and complete; 2) You authorize Bluewater International, Inc. to assign this application to Aqua Finance, Inc. or its assigns or any other financier; 3) You authorize a full investigation and release of any records from any source, including credit bureau reports, to check the accuracy of information on this application.