Credit Application Form

Name*

First NameLast Name

Email*

example@example.com

Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Date of Birth*

Date

Social Security Number*

Driver's License Number*

Are you currently working?*

YesNo

Employer or other Source of Income*

Position

Department

Monthly Net Income*

Status*

Joint Application

YesNo

Spouse or Co-Debtor name

First NameLast Name

Spouse or Co-Debtor Phone Number

Sposue or Co-Debtor SS#

Spouse or Co-Debtor Date of Birth

Date

Current Bank Name

Branch

Account Number

Account Type

CurrentSavingOther

Do you own your home?*

OwnRentOther

Do you have any current loans?*

YesNo

Loans

Loan Type*

Cash LoanUsed CarOther PurchaseOther

Requested Loan Amount ($500 minimum)*

in USD

Terms

1 year2 years3 years

Terms & Conditions

By filling this form we assume you accept terms and conditions. Do not continue to use Auto Credit Application if you do not agree to take all of the terms and conditions stated on this page.

By submitting your application for credit through this website, you are agreeing to the following statement:

Friendly Finance Discount Corporation (Creditor) may obtain and verify any information about me or my credit and employment history from credit reporting agencies, directly from my creditors, my landlord or other individuals or businesses, and current or former employers. I consent to such persons or entities providing such information to Creditor. I further authorized any creditor to whom I have applied for credit to share my information with Creditor. Additionally, I hereby guarantee that all the information provided in the attached application for credit is true and correct, and I acknowledge that I understand that Creditor is relying upon the complete accuracy of the information submitted and that false or misleading information may constitute an attempt to defraud Creditor.

Signature

Co-signer's. Signature

Please verify that you are human*

Credit Application Form

Applicant Details

Financial Details

Requested Loan Details