Applicant Information

Name (First, Middle, Last, Suffix):

Date of birth:

SSN:

Phone:

Current address:

City:

State:

ZIP Code:

(Please click)
 Rent Own

Monthly payment or rent:

How long?

Previous address:

City:

State:

ZIP Code:

(Please click)
 Rent Own

Monthly payment or rent:

How long?

Employment Information

Current employer:

Employer address:

How long?

Phone:

E-mail:

Fax:

City:

State:

ZIP Code:

Position:

(Please click)
 Hourly Salary

Annual income:

Previous employer:

Address:

How long?

Phone:

E-mail:

Fax:

City:

State:

ZIP Code:

Position:

(Please click)
 Hourly Salary

Annual income:

Name of a relative not residing with you:

Address:

Phone:

City:

State:

ZIP Code:

Relationship:

Co-Applicant Information, if for a joint account

Name:

Date of birth:

SSN:

Phone:

Current address:

City:

State:

ZIP Code:

(Please click)
 Owned Rented

Monthly payment or rent:

How long?

Previous address:

City:

State:

ZIP Code:

(Please click)
 Owned Rented

Monthly payment or rent:

How long?

Employment Information

Current employer:

Employer address:

How long?

Phone:

E-mail:

Fax:

City:

State:

ZIP Code:

Position:

(Please click)
 Hourly Salary

Annual income:

Previous employer:

Address:

Phone:

E-mail:

Fax:

City:

State:

ZIP Code:

Position:

(Please click)
 Hourly Salary

Annual income:

Application Information Continued

Name of a relative not residing with you:

Address:

Phone:

City:

State:

ZIP Code:

Relationship:

Credit Cards

Name

Account number

Current balance

Monthly payment

Mortgage Company

Account Number:

Address:

Auto Loans

Auto loans

Account number

Balance

Monthly payment

Other Loans, Debts, or Obligations

Description

Account number

Amount

Other Assets or Sources of Income

Description

Amount per month or value

I authorize SMF Cycles to verify the information provided on this form as to my credit and employment history.

Signature of applicant

Date

Signature of co-applicant, if for joint account

Date