What Type of Financing Plan Do You Want?   90 Days Same As Cash 6 Months Same As Cash Low Interest Monthly Payment Plan Heat Loan Plan Please Call 552-0808          
How Much Do You Want to Finance?  $2,500 $5,000 $7,500 $10,000 $15,000 $20,000  
                                                           
Primary Applicant                                      APPLICATION

First Name: M. Initial: Last Name: 

Mailing Address:   Do You: Own Your Home Rent

City:    State:     Zip:      Home Phone:   

Birth Date: mm/dd/yyyy   Social Security Number :   


Employer:  How Long Yrs:   Total Annual Income:  

Business Phone:

Joint Applicant Info

First Name: M. Initial: Last Name: 

Relationship to Primary:  Spouse Other    Mailing Address:

City:    State:     Zip:      Home Phone:   

Birth Date: mm/dd/yyyy   Social Security Number :   


Employer:  How Long Yrs:   Total Annual Income:  

Please read the following before completing this form: (1) Applicant represents that the information given in this Application is complete and accurate and authorizes us to check with credit reporting agencies, credit references and other sources disclosed herein investigating the information given. (2) Federal Law requires us to obtain, verify, and record information that identifies you when you open an account. We will use your name, address, date of birth, and other information for this purpose.