Lendmark Financial Services®

APPLICATION FOR CREDIT

Please complete all appropriate sections, providing at least two years residence and employment history. (If additional space is needed, please use back of this application.)

Applicant Information

First name

Middle name

Last name

Social Security:

Birthday

City

Region/State/Province

Postal / Zip code

Ho Long? Yrs. Mos.

Mailing Address: (if different from Residence Address)

Home Phone No.

Cell Phone No.

Previous Address: (if less than 2 years)

Ho Long? Yrs. Mos.

No Dependents

Landlord or Mortgage Holder:

Mortgage or Rent Payment (Mo.) $

Employer’s Name and Address

Occupation _

Ho Long? Yrs. Mos.

Work Phone No.

Monthly Income From Employer $

GROSS

NET

Previous Employer

All Other Monthly Income* $

Source(s) of Other Income

Total Monthly Income $

GROSS

NET

OTHER INCOME: (Read to applicant: “Income from alimony, child support, or separate maintenance need not be revealed if you do not choose to rely on such income in applying for credit.”)

Are you obligated to pay alimony, child support, etc.?

Auto Yr / Model

Financed By

Applicant

Co-applicant

CO-APPLICANT:

First name

Middle name

Last name

Social Security:

Birthday

City

Region/State/Province

Postal / Zip code

Ho Long? Yrs. Mos.

Home Phone No.

Cell Phone No.

No Dependents

Rent or payment/ Mo.

Employer’s Name and Address