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Consumer Credit Application :




Name :

Date :

Address :

City :

State :

Zip :

How long at address :

Own or Rent :

Employed by :

Position :

How long :

Salary $ :

No. dependents :

Type car owned :

Year :

Other sources of income: :

$ :

$ :

Outstanding obligations: :

$ :

$ :

$ :

$ :

Pending lawsuits: :

Have you filed bankruptcy within last 6 years? :

Credit references: :

Name :

Address :

Name :

Address :

Name :

Address :

Bank references: :

Name :

Address :

Checking :

Savings :

Visa Card :

Master Card :

American Express :

Other Credit Cards :

NOTICE :

When making applicatin for credit, it is understood that an investigation may be made whereby information is obtained through personal interviews with your neighbors, friends, or others with whom you are acquainted. This inquiry includes information as to your character, general reputation, personal characteristics, and mode of living. You have a right to make a written request within a reasonable period of time to receive additional, detailed information about the nature and scope of this investigation. :

Applicant :









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