Smart Finance Service

Online Credit Application

If you are applying for individual credit in your own name and are relying on your own income or assets and not the income or assets of another person as the basis for repayment of the credit requested, complete Sections A and C.

If this is an application for joint credit with another person, complete all Sections, providing information in Section B about the joint applicant. We intend to apply for joint credit (please initial).____________________Applicant ____________________ Co-Applicant

If you are applying for individual credit, but are relying on income from alimony, child support, or separate maintenance or on the income or assets or another person as the basis for repayment of the credit requested, complete all sections to the extent possible, providing information in B about the person upon whose alimony, support, or maintenance payments or income or assets you are relying.

Amount Requested:

Payment Date Desired

Proceeds of Credit to be Used for:

SECTION A-APPLICATION INFORMATION

Full Name (Last, First, Middle):

Social Security No:

Driver’s License No:

Birthdate:

Current Street Address: ___________________________ _______Years there:

City: _________________________________State: ______ Zip:_____________

Home Phone(H): ______________________ Mobile Phone(C):_______________________

Landlord/Mortgage Holder:

Monthly Rent/Mortgage:

Landlord Phone:

Previous Street Address:

Years there:

City: ____________________________State: __________ Zip:_______________

Monthly Rent/Mortgage at Previous Address

Current Employer

Phone:

Years There

Positions/Occupation

Employer Address

Previous Employer

Years There

Alimony, Child support, or separate maintenance Income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

Other Income $ Per

Source of other Income:

Reference

Relationship:

Phone:

Bank Reference:

Phone:

Checking

Savings

SECTION B SIGNATURES

Date

Month

Day

Year

Signature

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Signature

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SECTION C NOTICES

ALL APPLICANTS: IMPORTANT APPLICANT INFORMATION

You authorize us to obtain consumer credit reports from time to time as we want, for any legitimate purpose, in connection with the transaction that is proposed by this application or any future update, renewal, or extension of that transaction. Upon request, you will be informed whether or not a consumer report was ordered. If a report was requested, you will be informed of the name and address of the consumer credit reporting agency that furnished the report. We may keep this application whether or not it is approved. By signing below, you agree that the creditor may contact any party mentioned in this application to verify the information contained herein or otherwise underwrite credit. You authorize us to check your credit and employment history and to answer questions others may ask us about your credit record with us. You agree that we and any financial company that reviews this credit application may monitor and record your telephone communications to assure the quality of service. You authorize and give your consent to receive calls and text messages from the creditor or its third party debt collector at any number you have given us, including calls and messages made using an automatic telephone dialing system or prerecorded message.

By Signing below you acknowledge you have read the Applicable notice on this page and Agree to these Terms.

Date

Month

Day

Year

Signature

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