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Secure Credit Application

Fields in blue are required

Credit Application Type
Loan Information
Purpose of loan
Loan amount requested
Desired # of monthly payments
Desired monthly payment
Amount Down
# Miles on trade-in
Amount owed on trade-in
Applicant's Personal Information
Full Name
Marital Status
Social Security #
- -
Driver's License #
Driver's License Exp Date
Date of Birth
Email Address
Home Phone
Cell Phone
Applicant's Current Address
Street 1
Street 2
City / State / Zip
Have you lived here more than 5 years?
Have you lived here more than 5 years?

to authorize us to share your nonpublic personal information with affiliated and/or nonaffiliated third parties. I understand that in checking this that you may be better able to serve me and that I may receive offers for other products and services that may be of value to me. Please read our privacy policy for more information regarding your rights and how we use the personal information you submit to us.


This application for credit may be submitted by the Dealer to various financial institutions. Before this application is submitted, the Dealer will disclose to you the name and address of the institution(s) who will receive copies of this application.

By clicking on the 'submit' button below I certify that the above entered information to be true and correct and I hereby authorize you to use this information to perform a credit rating check of my personal credit. I also certify that I am over the age of 18 and am a current U.S. citizen or permanent resident. In addition, I understand that submitting the above information does not represent an obligation by any party to provide credit nor does it obligate me to accept any credit offered.

Coal Wholesale LLC
2106 Highway 98
Daphne, AL 36526
(251) 689-7744 RayRay
(251) 625-4701 Office
Monday 9:00AM - 6:00PM
Tuesday 9:00AM - 6:00PM
Wednesday 9:00AM - 6:00PM
Thursday 9:00AM - 6:00PM
Friday 9:00AM - 6:00PM
Saturday 9:00AM - 4:00PM
Sunday Closed