Tweety's Automart Credit Application

Name (Last, First) *

D.O.B. *

SS# *

DL Number *

State *

Address *

How Long? *

City *

State *

Zip *

Daytime Phone *

Evening Phone *

Cell Phone

Email Address

Landlord or Mortgage Co *

Landlord Phone *

Previous Address *

How Long *

City *

State *

Zip *

Present Employer *

Phone *

Location *

Position *

Supervisor *

Length of Employment *

Pay Period *

Weekly

Bi-Weekly

Monthly

Have you ever filed for Chapter 7 *

Yes

If so, when?

Have you ever filed for Ch. 13 *

Yes

If so, when

Date of Dismissal

Payment History Information (furniture, appliances, computers, rent to own, etc)

Business

Phone

What was purchased

Are you still making payments

Yes

If no, when was it paid off

Business

Phone

What was purchased

Are you still making payments

Yes

If no, when was it paid off

Personal References (must be filled out completely)

Parents or Guardian *

Home Phone *

Address *

Cell Phone

1. Name *

Relative

Friend

Address *

Contact Phone *

2. Name *

Relative

Friend

Address *

Contact Phone *

3. Name *

Relative

Friend

Address *

Contact Phone *

4. Name *

Relative

Friend

Address *

Contact Phone *

5. Name *

Relative

Friend

Address *

Contact Phone *

6. Name *

Relative

Friend

Address *

Contact Phone *

For the purpose of securing credit, I certify by my electronic signature that the above information is true and complete to the best of my knowledge. I authorize the lender to make whatever credit inquiries it deems necessary with this credit application or in the course of review or collection of any credit extended in reliance to this application.

Electronic Signature *

When you type out your name for an electronic signature, you must write is as such: "/John Doe/" with the "/" before and after your name.

Date of Application *

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