Purpose for loan:
First and Last Name:
Name of Mortgage Holder:
Mortgage or Rent Payment:
$ per month
Full Address of Mortgage Holder:
How long at Current Address?:
How long at Previous Address?:
APPLICANT’S EMPLOYMENT INFORMATION
$ Week Bi-Month Month
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?:
If Yes, How Much?:
Have you filed bankruptcy in the last Ten Years?
Do you have medical bills?
Previous Employer Address:
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?
Will spouse use the account?
Is applicant relying on spouse’s income (or community property) for repayment?
Is applicant relying on alimony, child support or separate maintenance payments from spouse(or former spouse) for repayment?
SPOUSE INFORMATION-IF APPLICABLE
Spouse Home phone:
Spouse Business phone:
Week Bi-Month Month
CREDIT REFERENCES (Show Name, Address & Account Number)
Please check all that apply.
Make & Year of Auto:
Nearest relatives NOT LIVING with you:
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.