Borrower's Information
Co-Borrower Information
Last Name
First Name
Street Address
City
State
Zip
Time at Current Residence
Date of Birth
Social Security #
Employer
Employment Length
Income and Expense Information
Monthly Salary (Include Taxes)
Bonuses (Average for a Year)
Any Other Monthly Income
Monthly Mortgage Payment or Rent
Auto & Other Monthly Payments
Monthly Credit Card Payments
Contact Information
Email Address
Home Phone
Work Phone
Comments:
YOU UNDERSTAND THAT THE HOME RETAILER EXTENDS CREDIT AT DIFFERENT RATES AND CREDIT TERMS AND AGREE THAT YOU ARE APPLYING FOR AN EXTENSION OF CREDIT AND NOT FOR A PARTICULAR RATE OR PARTICULAR CREDIT TERMS.