Marietta

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

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 fill out the application below for the Marietta Branch.

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