Residential Services Credit Application First Name * Last Name * Date of Birth * Telephone # * Cell Phone # * Email * How did you hear about Lykins Energy Solutions? Check all that apply * Bill Board TV Commercial Radio Commercial Sporting Events Saw a Lykins Truck Social Media Source Internet Ad Mail Piece/Postcard Phone Book Friends Sales Person Present Address * City * State * Zip * How many years at present address? * Do you own or rent? * OwnRentOther Previous address if less than 3 years at present address Present Occupation * How Long * Salary * Present Employer * Employer Phone # * Other Income Monthly Source Name of nearest relative not living with you * Number of dependents * Co-Applicant Name Co-Applicant Date of Birth Co-Applicant Telephone # Co-Applicant Cell Phone # Co-Applicant Email Co-Applicant Present Address Co-Applicant City Co-Applicant State Co-Applicant Zip Co-Applicant How many years at present address? Co-Applicant Do you own or rent? Choose OneOwnRentOther Co-Applicant Previous address if less than 3 years at present address Co-Applicant Present Occupation Co-Applicant How Long? Co-Applicant Salary Co-Applicant Present Employer Co-Applicant Employer Phone # Co-Applicant Other Income Co-Applicant Name of nearest relative not living with you Co-Applicant Monthly Source Co-Applicant Number of Dependents Creditor #1 Name Creditor #1 Address Creditor #1 Account # Creditor #1 Monthly Pay Creditor #1 Balance Creditor #2 Name Creditor #2 Address Creditor #2 Account # Creditor #2 Monthly Pay Creditor #2 Balance Creditor #3 Name Creditor #3 Address Creditor #3 Account # Creditor #3 Monthly Pay Creditor #3 Balance Creditor #4 Name Creditor #4 Address Creditor #4 Account # Creditor #4 Monthly Pay Creditor #4 Balance The Ohio laws against discrimination require all creditors to make credit available to all credit worthy customers and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio civil rights commission administers compliance with this law.The undersigned hereby fully guarantees the payment of this credit extension and agrees to repayment terms and conditions that LYKINS ENERGY SOLUTIONS may set up, and waives any notice of default regarding credit extensions; whether that credit extension be to an individual, group, proprietorship, partnership, corporation, or dba. You are authorized to check my credit and to release information about your credit experience with me. Applicant Signature * Sign Date * Co-Applicant Signature Sign Date