Oak Only | Furniture Store Scranton | Furniture Store Clarks Summit

Personal Information
Your Full Name:
Email Address:
Street Address:
City:
State::
Zip:
Phone #:	(include area code)
Social Security #:
Date of Birth:
Rent by:	Month Lease Own
Landlord or Mortgage Holder:
Landlord or Mortgage Holder Address:
Mthly Payment/Rent:
Time at Residence:
Name of Employer:
Employer Address:
Employer Phone #:
City:
State::
How long employed there:
Annual Income:
Check here if you are seeking financing with a co-applicant
Special explanations or questions?
Electronic Signature(type your name here): PLEASE READ: By submitting this form, I certify that the information provided on this application is, to the best of my knowledge, complete and accurate. I understand that the financial institution(s) will rely on this information to judge my credit worthiness, and will retain this application and information about me whether or not this application is approved. Further, I authorize an investigation of my credit and employment history. I authorize the lender to release information about its experience with me. I understand that false statements may subject me to criminal penalties. FAIR CREDIT REPORTING ACT DISCLOSURE: This application for credit may be submitted by the Dealer to various financial institutions.