Credit Application
First Name
Last Name
Email
Phone
Street Address
City
State
Zip
Drivers License #
Social Security #
Date Of Birth
Housing Status
Rent
Own
Live with Parent(s)
Monthly Rent/Mortgage
Current Time at Residence
Less than 6 months
6 months to a year
1 to 2 years
2 to 5 years
5 years or more
Employer
Occupation
Work Phone
Length of Employment
Less than 6 months
6 months to a year
1 to 2 years
2 to 5 years
5 years or more
Monthly Gross
Other Income
ACKNOWLEDGMENT AND CONSENT:
I certify that the above information is complete and accurate to the best of my knowledge. Creditors receiving this application will retain the application whether or not it is approved. Creditors may rely on this application in deciding whether to grant the requested credit. False statements may subject me to criminal penalties. I authorize the creditors to obtain credit reports about me on an ongoing basis during this credit transaction and to check my credit and employment history on an ongoing basis during the term of the credit transaction. If this application is approved, I authorize the creditor to give credit information about me to its affiliates.