Lawrenceville

verisign-securePlease fill out the application below for the Lawrenceville Branch.

558 Old Norcross Rd.
Suite 107
Lawrenceville, GA 30046
Office: 770-339-8555

Purpose for loan:
First and Last Name: D.O.B. SSN Married Home phone:
Unmarried
Address: City: State: Zip Code: Separated Business:

Widowed
Name of Mortgage Holder: Mortgage or Rent Payment: Cell:
$per month
Full Address of Mortgage Holder: How long at Current Address?: Email:
years months
Previous Address: How long at Previous Address?:
years months
APPLICANT’S EMPLOYMENT INFORMATION
Employer: Occupation: Phone Number: How long?:
years months
Employer Address: City: State: Zip Code: Income:
$ Week Bi-Month  Month
Other Income:
Alimony, Child Support, Separate Maintenance Payments need not be disclosed unless relied upon for payments or credit support
Explain other income below: Do you PAY child support?:
YES
NO		 If Yes, How Much?:
$ 
Month
Week
Have you filed bankruptcy in the last Ten Years? Do you have medical bills?
YES NO YES NO
Previous Employer: Occupation: State: Zip Code: How long?:
YearsMonths
Previous Employer Address: City:
Applicant should provide requested information on spouse, if answer is “YES” to one or more of the following questions:
Will spouse sign the agreement or contract?
YES
NO
Will spouse use the account?
YES
NO
Is applicant relying on spouse’s income (or community property) for repayment?
YES
NO
Is applicant relying on alimony, child support or separate maintenance payments from spouse(or former spouse) for repayment?
YES
NO
SPOUSE INFORMATION-IF APPLICABLE
Spouse’s Name: Spouse D.O.B. Spouse SSN Spouse Home phone:
Spouse Address: City: State: Zip Code: Spouse Business phone:

Spouse Employer: Occupation: Phone Number: How long?:
Years Months
Employer Address: City: State: Zip Code: Income:
$WeekBi-MonthMonth

CREDIT REFERENCES (Show Name, Address & Account Number)
Credit Cards
Please check all that apply.		 VISA Mastercard American Express Discover
Bank: Bank Address:
Make & Year of Auto:
Nearest relatives NOT LIVING with you: Phone Numbers: Addresses:

Fair Credit Reporting Act to customer: Buyer’s credit application will be submitted for consideration to Wilkes Finance or one of its affiliates.

Notice to applicant: A consumer report may be requested with the processing of your credit. Upon request, you will be informed whether or not a consumer report was requested, and if such a report was requested, informed of the name and address of the consumer reporting agency that furnished the report. Subsequent consumer reports may be requested or utilized in connection with an update, renewal or extension of credit or collection. I / we authorize you to investigate credit and employment history and understand that if I / we do not qualify for the requested amount, you may consider me for a lesser amount.
I agree with the above statement. Requested Amount: $
I DO NOT agree with the above statement.

Please click “Submit” only once.